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Summary  of  Actions 
of  House 
of  Delegates 
Page  57 


July,  1970 

VoI.138/No.1  Contents  page  5 


HEALTH  SCIENCES  LlBRAR'«. 


BALTlHkX^ 


Flagyl 

brand  of 

metronidazole 


vaginitis 

therapy 


I 


The  effectiveness  of  Flagyl  in  Trichomonas  vaginalis  vaginitis  has  been  so  constant 
that  use  of  less  effective  agents  would  seem  to  invite  unnecessary  failures.  ■ The 
simplicity,  completeness  and  persistence  of  cures  with  Flagyl  qualify  it  as  the  logical 
first  therapeutic. choiceJiT  trichomonal  infections. 

Ten-day  treatment  with  Flagyl  oral  tablets  has  replaced  a multitude 
of  untidy  douches,  powders,  creams  and  jellies. 

Flagyl  is  the  only  medication  available  that  is  able  to  reach  all  the 
crypts,  glands  and  cavities  of  the  female  urogenital  system  as  well 
as  reservoirs  of  reinfection  in  male  trichomonas  carriers. 

Flagyl  eradicates  resistant,  deep-seated  invasions  of  Trichomonas 
vaginalis  and  consistently  produces  cure  rates  above  90  per  cent 
and  often  as  high  as  100  per  cent  in  large  series  of  patients.  When 
the  diagnosis  is  positive,  Flagyl  is  positive. 


Indications:  For  the  treatment  of  trichomoniasis  in  both  male  and  female  patients  and  the  sexual  partners  of  patients 
with  a recurrence  of  the  infection  provided  trichomonads  have  been  demonstrated  by  wet  smear  or  culture.  ■ Con- 
traindications: Evidence  of  or  a history  of  blood  dyscrasla,  in  patients  with  active  organic  disease  of  the  central 
nervous  system,  and  the  first  trimester  of  pregnancy.  ■ Warnings:  Use  with  discretion  during  the  second  and  third 
trimesters  of  pregnancy  and  restrict  to  patients  not  cured  by  topical  measures.  Flagyl  is  secreted  in  the  breast  milk 
of  nursing  mothers;  it  is  not  known  whether  this  can  be  injurious  to  the  newborn.  ■ Precautions:  Mild  leukopenia 
has  been  reported  during  Flagyl  use;  total  and  differential  leukocyte  counts  are  recommended  before  and  after  treat- 
ment with  the  drug,  especially  if  a second  course  is  necessary.  Avoid  alcoholic  beverages  during  Flagyl  therapy 
because  abdominal  cramps,  vomiting  and  flushing  may  occur.  Discontinue  Flagyl  promptly  if  abnormal  neurologic 
signs  occur.  There  is  no  accepted  proof  that  Flagyl  is  effective  against  other  organisms  and  it  should  not  be  used 
in  the  treatment  of  other  conditions.  Exacerbation  of  moniliasis  may  occur.  ■ Adverse  Reactions:  Nausea,  headache, 
anorexia,  vomiting,  diarrhea,  epigastric  distress,  abdominal  cramping,  constipation,  a metallic,  sharp  and  unpleasant 
taste,  furry  or  sore  tongue,  glossitis  and  stomatitis  possibly  associated  with  a sudden  overgrowth  of  Monilia,  exacerba- 
tion of  vaginal  moniliasis,  an  occasional  reversible  moderate  leukopenia,  dizziness,  vertigo,  drowsiness,  incoordina- 
tion and  ataxia,  numbness  or  paresthesia  of  an  extremity,  fleeting  joint  pains,  confusion,  irritability,  depression, 
insomnia,  mild  erythematous  eruptions,  “weakness,”  urticaria,  flushing,  dryness  of  the  mouth,  vagina  or  vulva,  vaginal 
burning,  pruritus,  dysuria,  cystitis,  a sense  of  pelvic  pressure,  dyspareunia,  fever,  polyuria,  incontinence,  decrease 
of  libido,  nasal  congestion,  proctitis,  pyuria  and  darkened  urine  have  occurred  in  patients  receiving  the  drug. 
Patients  receiving  Flagyl  may  experience  abdominal  distress,  nausea,  vomiting  or  headache  if  alcoholic  beverages 
are  consumed.  The  taste  of  alcoholic  beverages  may  also  be  modified.  ■ Dosage  and  Administration:  in  the  Female. 
One  250-mg.  tablet  orally  three  times  dally  for  ten  days.  Courses  may  be  repeated  if  required  in  especially  stubborn 
cases;  in  such  patients  an  interval  of  four  to  six  weeks  between  courses  and  total  and  .differential  leukocyte  counts 
before,  during  and  after  treatment  are  recommended.  Vaginal  Inserts  of  500  mg.  are  available  for  use,  particularly  in 
stubborn  cases.  When  the  vaginal  inserts  are  used,  one  500-mg.  insert  is  placed  high  in  the  vaginal  vault  each  day 
for  ten  days  and  the  oral  dosage  is  reduced  to  two  250-mg.  tablets  daily  during  the  ten-day  course  of  treatment.  Do 
not  use  the  vaginal  Inserts  as  the  sole  form  of  therapy.  In  the  Male.  Prescribe  Flagyl  only  when  trichomonads  are 
demonstrated  in  the  urogenital  tract,  one  250-mg.  tablet  two  times  daily  for  ten  days.  Flagyl  should  be  taken  by  both 
partners  over  the  same  ten-day  period  when  It  is  prescribed  for  the  male  in  conjunction  with  the  treatment  of  his 
female  partner.  ■ Dosage  Forms:  Oral  tablets 250  mg.  Vaginal  Inserts 500  mg. 

G.  D.  SEARLE  & CO. 

Research  in  the  Service  of  Medicine 


941 


Illinois  Medical  Journal 

volume  138,  number  1 ]^dy,  1970 

Editor  - Theodore  R.  Von  Dellen,  M.D. 

Managing  Editor  Richard  A.  Ott 

Medical  Progress  Editor  Harvey  Kravitz,  M.D. 

Editorial  Assistant  - - - Michaelyn  Sloan 

Advertising  Manager  John  A.  Kinney 

Executive  Administrator  Roger  N.  White 

J 

\ 


CONTENTS 


! ILLINOIS  STATE 

I MEDICAL  SOCIETY 

I ' 

\ ! 360  N.  Michigan  Ave.,  Chicago,  60601 

I OFFICERS 

J.  Ernest  Breed,  President 

55  East  Washington  Street,  Chicago  60602 
L.  T.  Fruin,  President-Elect 

5 Citizen's  Square,  Normal,  61761 
George  C.  Shropshear,  1st  Vice-President 
1525  East  53rd  Street,  Chicago,  60615 
C.  J.  Jannings,  III,  2nd  Vice-President 
101  East  Center  Street,  Fairfield,  62837 
Jacob  E.  Reisch,  Secretary-Treasurer 

1129  South  2nd  Street,  Springfield  62704 
jPaul  W.  Sunderland,  Speaker 

214  North  Sangamon  St.,  Gibson  City,  60936 
Andrew  J.  Brislen,  Vice-Speaker 
j 6060  South  Drexei  Blvd.,  Chicago  60637 
Willard  C.  Scrivner,  Chairman  of  the  Board 
4601  State  Street,  East  St.  Louis,  62205 

TRUSTEES 

I Joseph  L.  Bordenave,  1st  District  (1971) 

) 1665  South  Street,  Geneva,  60134 

[William  A.  McNichols,  Jr.,  2nd  District  (1971) 
101  West  First  Street,  Dixon,  6^021 
jFredric  D.  Lake,  3rd  District  (1972) 

■ 1041  Michigan  Avenue,  Evanston,  60202 

I James  B.  Hartney,  3rd  District  (1973) 

I I 410  Lake  Street,  Oak  Park,  60302 
I [Frank  J.  Jirka,  3rd  District  (1971) 
i 1 1507  Keystone  Ave.,  River  Forest,  60305 

William  M.  Lees,  3rd  District  (1971) 

I 6518  N.  Nokomis,  Lincolnwood,  60646 
Frederick  E.  Weiss,  3rd  District  (1973) 

! 15643  Lincoln  Avenue,  Harvey,  60426 

Warren  W.  Young,  3rd  District  (1972) 

10816  Parnell  Avenue,  Chicago,  60628 
I Fred  Z.  White,  4th  District  (1973) 

723  North  Second  St.,  Chillicothe,  61523 
A.  Edward  Livingston,  5th  District  (1973) 

219  North  Main,  Bloomington,  61701 
J.  Mather  Pfeiffenberger,  6 District  (1972) 

State  & Wall  Streets,  Al’on,  62002 
Arthur  F.  Goodyear,  7th  District  (1973) 

142  East  Prairie  Avenue,  Decatur,  62523 
Eugene  P.  Johnson,  8th  District  (1973) 

22  West  Main  Street,  Casey,  62420 
Charles  K.  Wells,  9th  District  (1972) 

117  North  10th  Street,  Mt.  Vernon,  62864 
Willard  C.  Scrivner,  10th  District  (1972) 

4601  State  Street,  East  St,  Louis,  62205 
Joseph  R.  O'Donnell,  11th  District  (1971) 

' 444  Park,  Glen  Ellyn,  60137 

Edward  W,  Cannady,  Trustee-at-Large 

! 4601  State  Street,  East  St.  Louis,  62205 


Microfilm  copies  of  current  as  well  as  some  back 
issues  of  the  Illinois  Aiedical  Journal  may  be 
purchased  from  Xerox  University  Microfilms,  300 
SJ.  Zeeb  Road,  Ann  Arbor,  Mich.,  48106. 


ABSTRACTS  OF  BOARD  ACTIONS  19 

CONVENTION  SUMMARY 

1970-71  Officers  and  Hoard  ol  rriistees  58 

Convention  Highlights  59 

Sunmiary  ol  House  ol  Delegates  Actions  63 

.\ctions  on  Resohitions  _ ....68 

CLINICAL  ARTICLES 

Popliteal  .^neurysin:  ,\n  Uniesolvetl  Problem 

Richard  C.  Powers,  M.D.,  F.A.C.S.,  and  Isa  Sejdinaj.  M.D '^3 

Failtire  ol  Thymectomy  in  a Six-Year-Old 
Child  with  Myasthenia  Gravis 
Chang  Hwan  Kim,  M.D.,  Bennett  R.  Sherman,  M.D.. 

and  Meyer  A.  Perlstein,  M.D - 44 

Evaluation  of  Hypnotic  Eifect  of  Methacpialone 
Employing  Placebo  Responder  Elimination 

Arpad  At  massy,  M.D 73 

Leprosy  in  Ceylon 

Larry  D.  Greenfield . M.D 87 

MEDICAL  PROGRESS 

Contemjjorai  y Practices  in  Ophthalmology 
John  G.  Bellows,  M.D.,  Ph.D 47 

SURGICAL  GRAND  ROUNDS 

Lireteral  Objtriution  37 

FEATURES 

Blue  Shield  Report  1 

The  President’s  Page  11 

Clinics  lor  Crippled  Children  ,d6 

New  Phai maceutical  Specialties  26 

Illinois  Medical  Assistants  .Yssociation  31 

Meeting  Memos  31 

Public  Affairs  Library  _ 43 

Editoi  ials 55 

The  View  Box  70 

Socio-Economic  News  81 

The  Doctor’s  Library  84 

Obituaries  ; .Si 91 


(Cover  story  on  fnige  16) 


Publications  Committee 

Jacob  E.  Reisch.  M.D.,  Chairman 
Fredric  D.  Lake,  M.D. 

Charles  K.  Wells,  M.D 
Warren  W.  Young,  M.D. 


Editoria  Board 


Harvey  Kravitz,  M.D. 
Chairman 

Charles  Mrozek,  M.D. 
C.  J.  Mueller,  M.D. 


Frederick  Steigman,  M.D. 
Frederick  Stenn,  M.D. 
Arkell  M.  Vaughn,  M.D. 


Published  monthly  by  the  Illinois  Stale  :\Iedical 
Society,  360  N.  ^richigan  Ave.,  Chicago.  111.,  60601. 
Copyright  1970.  The  Illinois  State  Medical  Society. 

Subscription  $5.00  per  year,  in  advance,  postage 
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•nion.  Canada  $5.50  U.S.  Single  current  copies 
.vailable  at  7oc. 

Second  class  postage  paid  at  Chicago,  111.  and  at 
dditional  mailing  oftices.  When  moving  please  notify 


Journal  office  of  new  address  including  old  mailing 
label  with  notification,  if  possible.  POSTMASTER: 
Send  notice  on  form  No.  3579  to  Illinois  State 
Medical  Society.  360  N.  Michigan  Ave.,  Chicago. 
111.  60601. 

Pharmaceutical  advertising  must  be  approved  by 
the  ISMS  Publications  Committee.  Other  advertising 
accepted  after  review  by  Publications  Committee  or 
Board  of  Trustees.  All  copy  or  plates  must  reach  the 
•Tournal  office  by  the  fifteenth  of  the  month  preceding 
publication.  Rates  furnished  upon  request. 


Original  articles  will  be  considered  for  publication 
with  the  understanding  that  they  are  contributed  only 
to  the  Illinois  Medical  Journal.  The  ISMS  denies 
responsibility  for  opinions  and  statements  expressed  by 
authors  or  in  excerpts,  other  than  editorial  or  allied 
views  or  statements  which  reflect  the  authoritative 
action  of  the  ISMS  or  of  reports  on  official  actions, 
policies  or  positions.  Views  expressed  by  authors  do 
not  necessarily  represent  those  of  the  Society;  any 
connection  with  olficial  policies  is  coincidental. 


/or  Ixtly,  1970 


5 


The  First  Freedom 


Being  free  to  care 
for  your  patients  because 
The  First  is  caring  for 
your  investments. 


You  can't  manage  a thriving 
practice  and  a successful  securities 
portfolio  simultaneously.  Even  if 
you  had  the  time.  Because  your 
speciality  is  medicine.  Not 
investments. 

Investment  Advisory  Service  is  our 
speciality.  Full  time.  And  portfolio 
management  is  as  specialized  to  us 
as  your  practice  is  to  you.  That’s 
why  The  First  National  Bank  of 
Chicago  can  free  you  from 
investment  worries. 

At  your  convenience,  a First 
Investment  Account  Manager  will 
sit  down  with  you.  In  complete 
privacy.  Together,  you’ll  review  your 


investments.  Together,  you’ll  agree 
on  a set  of  realistic,  attainable 
objectives.  Quality  long-term  growth, 
income,  tax  advantages — literally 
every  aspect  will  be  thoroughly 
explored. 

Then,  with  your  unique  objectives 
in  mind,  your  personal  Investment 
Account  Manager  will  design  a 
financial  program  that's  yours  alone. 
A program  backed  by  the  combined 
experience  and  expertise  of  the  most 
sophisticated  money-managers 
in  Chicago. 

Your  account  can  be  under  your 
complete  control,  or,  if  you  prefer, 
your  Account  Manager  will  assume 


full  discretion.  Either  way,  your  pl( 
will  be  fully  and  frequently  review 
with  you  to  keep  pace  with  changit 
market  conditions  and  to  capitalize 
on  new  investment  opportunities. 

If  you  have  $300,000  or  more  ar 
you'd  like  to  enjoy  The  First 
Freedom,  call  Ward  Farnsworth  at 
(312)  732-4300.  He  can  free  you 
from  worry. 

The 

First  National  Ban| 
of  Chicago 

Investment  Advisory  Service. 


Blue  Shield  Board  Members 
Elected  to  High  AMA  Posts 


Walter  C.  Bornemeier,  M.D.,  Chicago,  a Trus- 
tee of  Illinois  Blue  Shield,  became  the  125th  Presi- 
dent of  the  American  Medical  Association  and  was 
inaugurated  at  its  annual  meeting  Wednesday, 
June  24,  in  the  Grand  Ballroom  of  the  Palmer 
House.  Dr.  Burtis  E.  Montgomery,  Chairman  of  the 
American  Medical  Association’s  Board  of  Trustees 
and  also  a Trustee  of  Illinois  Blue  Shield  adminis- 
tered the  oath  of  office. 

Dr.  Bornemeier  has  served  on  the  Board  of  Trus- 
tees of  the  Blue  Shield  Plan  of  Illinois  Medical 
Service  since  1953.  In  1963  he  was  elected  Vice- 
Speaker  of  the  AMA  House  and  was  elected  Speak- 
er in  1966. 

Burtis  E.  Montgomery,  M.D.,  Harrisburg,  has 
served  on  the  American  Medical  Association  Board 
since  1966  and  on  the  Board  of  Trustees  of  Blue 
Shield  since  1958.  He  was  President  of  the  Illinois 
State  Medical  Society  in  1966  and  was  Chairman 
of  its  Board  of  Trustees  from  1958  to  1960. 

Dr.  Bornemeier,  left,  and  Dr.  Montgomery,  right, 
are  shown  in  the  above  photograph  during  the 
inauguration  ceremony. 


Why  Some  Blue  Shield 
Claims  Are  Delayed 

A study  of  Blue  Shield  claims  has  been  made  to 
determine  the  reasons  why  payments  have  been 
delayed  and  to  help  us  make  payments  to  physi- 
cians more  promptly. 

The  primary  cause  for  delay  in  Blue  Shield  pay- 
ments is  due  to  incomplete  information  on  the  Blue 
Shield  Physician’s  Service  Report  form. 

In  order  to  speed  payments  to  you,  it  is  necessary 
for  us  to  have  the  following  infonnation. 

On  anesthesia  claims,  please  provide  the  follow- 
ing information  on  the  Blue  Shield  claim  form. 

( a ) The  time  of  the  anesthesia 

( b ) The  charge  for  anesthesia 

( c ) Particular  attention  should  be  given  to  claims 
submitted  for  anesthesia  administered  during 
a dilation  and  curettage  of  the  uterus.  Please 
indicate  whether  the  procedure  was  per- 
formed for  obstetrical  purposes.  It  is  sug- 
gested that  you  either  provide  the  diagnosis 
or  simply  state  Dilation  and  Curettage  “ob- 
stetrical” or  “non-obstetrical”.  This  is  neces- 
sary because  of  the  high  volume  of  claims 
submitted  for  this  procedure. 

On  claims  submitted  for  surgical  procedures, 
please  include  the  following  information  on  the 
Blue  Shield  Physician’s  Service  Report  form. 

(a)  Itemization  of  all  charges. 

This  is  particularly  important  in  order  to  make 
payment  to  physicians  bn  the  basis  of  their  Usual 
and  Customary  charges  for  Blue  Shield  members 
who  are  protected  by  our  Usual  and  Customary 
program. 

(b)  When  reporting  surgical  procedures,  please 
do  not  use  such  names  as,  “Strassman  proce- 
dure” or  “Nissen  procedure”.  Payments  will 
be  made  more  promptly  if  you  use  standard 
medical  nomenclature. 

Claims  for  radiation  therapy  are  often  delayed 
because  the  diagnosis  is  not  included  on  the  Physi- 
cian’s Service  Report.  By  reviewing  the  claims  be- 
fore they  are  submitted  to  Blue  Shield  unnecessary 
delay  can  be  prevented  and  the  necessity  to  contact 
you  or  your  medical  assistant  for  additional  infor- 
mation can  be  avoided. 


(This  is  not  an  advertisement) 


ASK  BLUE  SHIELD 


...  ABOUT  MEDICARE 

Services  in  an 
Extended  Care  Facility 

Because  misunderstandings  still  exist  over  pay- 
ments for  services  in  Extended  Care  Facilities,  we 
have  undertaken  a series  of  articles  which  began  in 
the  May  issue  of  the  Illinois  Medical  Journal  to 
inform  Illinois  physicians  of  covered  services  paid 
for  by  Medicare  so  they  will  be  in  a better  position 
to  advise  their  patients  that  some  services  may  not 
be  covered  and  alternative  financing  arrangements 
may  have  to  be  made. 

Examples  of  covered  Medicare  services  in  Ex- 
tended Care  Facilities  are  continued  in  this  report. 

Braces  and  similar  devices: — Routine  care  in 
connection  with  such  appliances  would  not  con- 
stitute skilled  services.  Training  in  the  proper  use 
of  a particular  appliance  should  be  evaluated  in  re- 
lation to  the  need  for  physical  therapy. 

Heat  treatments: — The  therapeutic  use  of  sun 
lamps,  infrared  lamps,  diathermy  and  similar  equip- 
ment constitutes  skilled  care  when: 

1.  the  service  is  specifically  ordered  by  a physi- 
cian as  part  of  an  active  treatment  regimen; 
and 

2.  the  observation  by  skilled  personnel  is  re- 
quired in  order  to  evaliiate  adequately  the 
results  of  the  treatment  and  inform  the  physi- 
cian of  the  patient’s  progress. 

Use  of  such  equipment  for  palliative  purposes  or 
comfort  is  not  a skilled  service  and  would  not  be  a 
Medicare  benefit. 

Restraints: — The  use  of  protective  restraints  such 
as  bed  rails,  soft  binders  and  supports  for  wheel 
chair  patients  generally  does  not  require  the  ser- 
vices of  skilled  personnel. 

Administration  of  medical  gas: — Any  regimen  re- 
quiring the  administration  of  medical  gases  would 
be  started  only  upon  the  physician’s  order.  The 
initial  phase  of  such  a regimen  would  be  skilled 
care.  However,  when  the  administration  becomes 
routine,  it  would  not  generally  be  considered  a 
skilled  services  because  patients  can  usually  be 
taught  to  operate  their  own  inhalation  equipment. 

Restorative  nursing: — Restorative  nursing  proce- 
dures constitute  skilled  services  when  they  are  pre- 
scribed by  a physician,  are  designed  to  restore 
functions  which  have  been  lost  or  reduced  by  ill- 
ness or  injury,  and  are  a type  whose  performance 
requires  the  presence  of  licensed  nurses.  In  many 
instances,  such  procedures  would  be  an  adjunct  to 
an  intensive  program  of  physical  therapy. 


When  a patient  has  reached  his  restoration  po- 
tential, the  services  required  to  maintain  him  at 
this  level  generally  would  not  constitute  skilled 
nursing  care,  nor  would  supervision  of  exercises 
which  have  been  taught  to  the  patient  be  consid- 
ered skilled  services. 

Physical  therapy,  one  aspect  of  restorative  care, 
consists  of  the  application  of  a complex  and  sophis- 
ticated group  of  physical  modalities  and  therapeutic 
services.  Physical  therapy,  therefore,  is  a skilled 
service.  Because  the  statute  defines  extended  care 
as  skilled  nursing  care  on  a continuing  basis,  pro- 
vision of  physical  therapy  only  would  not  justify  a 
finding  that  the  patient  requires  extended  care.  In 
some  situations,  a patient  whose  primary  need  is 
for  physical  therapy  will  also  require  sufficient 
skilled  nursing  to  meet  the  definition  of  extended 
care.  The  need  for  such  supportive  skilled  nursing 
on  a continuing  basis  may  be  presumed  when: 

1.  the  therapy  is  directed  by  the  physician  who 
determines  the  need  for  therapy,  the  capacity 
and  tolerance  of  the  patient,  and  the  treatment 
objectives;  and 

2.  the  physician,  in  consultation  with  the  ther- 
apist, prescribes  the  specific  modalities  to  be 
used  and  frequency  of  therapy  services;  and 

3.  the  therapy  is  rendered  by  or  under  the  su- 
pervision of  a physical  therapist  who  meets 
the  qualifications  established  by  regulations; 
when  the  qualified  therapist  is  the  supervisor, 
he  is  available  and  on  the  premises  of  the  fa- 
cility while  the  therapy  is  being  given,  he 
makes  regular  and  frequent  evaluations  of  the 
patient,  records  findings  on  the  patient’s  chart, 
and  communicates  with  the  physician  as  in- 
dicated; and 

4.  the  therapy  is  for  the  restoration  of  a lost  or 
impaired  function.  For  example,  frequent 
physical  therapy  treatments  in  connection 
with  a fractured  back  or  hip  or  a CVA  can  be 
presumed  to  be  directed  toward  restoration  of 
lost  or  impaired  function  during  the  early 
phase — when  physical  therapy  can  be  pre- 
sumed to  be  effective.  However,  when  the 
condition  has  been  stabilized,  the  presumption 
that  continuing  supportive  skilled  nursing  ser- 
vices are  required  is  no  longer  valid.  Such 
cases  must  be  evaluated  in  relation  to  the  spe- 
cific amount  of  skilled  nursing  attention  re- 
quired in  the  individual  case  and  supported 
by  the  physician’s  orders  and  nursing  notes. 

The  discussion  of  services  in  extended  care  facili- 
ties will  be  continued  in  the  next  issue  of  this  re- 
port. 

Notice  of  changes  in  Certification 

The  Social  Security  Administration  has  announced 
that  Medicare  can  reimburse  for  selected  laboratory 
procedures  performed  by  the  following  laboratory: 
Colton  Microbiology  Laboratory 
555  North  Monroe 
Hinsdale,  Illinois  60521 


CThis  is  not  an  advertisement) 


J.  Ernest  Breed 


Tlie 

President’s 

Page 


Responsibility 


The  responsibility  lor  the  health  of  all 
the  people  in  the  United  States  is  still  the 
privilege  of  the  American  medical  proles- 
sion,  but,  as  the  problems  become  more 
complex,  others  loudly  proclaim  the  need 
for  a change  in  management.  The  difficul- 
ties we  face  are  profound— the  increasing 
cost,  the  increasing  number  of  recjuired 
services,  the  need  for  increasing  numbers 
of  assistants  with  diverse  skills,  the  declara- 
tion of  health  care  as  a right,  the  increas- 
ing demands  by  those  previously  unin- 
formed as  they  learn  health  for  them  is 
possible,  the  fractionation  of  the  profession 
into  specialties  and  sidjspecialties— all  of 
these  and  many  other  factors  compound  our 
problem.  Of  course,  if  we  wish  to  abdicate, 
others  would  be  glad  to  relieve  us  of  con- 
trol over  the  health  team. 

Since  few  of  us  woidd  forsake  our  call- 
ing, we  in  the  Medical  Society  plan  to  pro- 
ceed in  all  manners  possible  to  discharge 
our  responsibilities  to  the  public. 

As  outlined  in  my  inaugural  address,  four 
areas  require  priority  in  our  immediate 
activities. 

In  Continuing  Education  we  plan  to 
cooperate  with  the  University  of  Illinois 
and  other  schools  to  establish  the  most 
feasible  methods  to  assist  physicians  in 
keeping  up  with  the  rapid  changes  in  scien- 
tific knowledge.  We  also  hope  to  place  em- 
phasis on  the  “art”  of  medicine,  since  it 
does  little  good  to  have  the  correct  diag- 


nosis if  the  patient  refuses  to  accept  it  or 
the  prescribed  treatment. 

Peer  Review  not  only  is  necessary  as  a 
third  party  reepurement,  but  it  serves  as  a 
subconscious  stimulant  to  keep  members 
abreast  of  new  techni(jues.  It  also  serves  as 
a guarantee  of  quality  care  for  the  patient 
and  protects  the  physicians  from  unjust 
accusations. 

Malpractice  claim  increases  require  a 
defensive  crash  program  which  we  hope  to 
inaugurate  soon.  It  involves  the  provision 
of  a panel  of  experts  for  screening  threat- 
ened suits.  It  is  hoped  this  procedure  will 
fractionate  the  number  of  claims. 

Changes  In  the  Health  Care  Delivery 
System  are  designed  to  take  advantage  of 
modern,  efficient  business  methods,  the  use 
of  allied  health  assistants,  computers,  mod- 
ern methods  of  communication,  etc.  You 
will  hear  much  more  of  this  later,  but  it 
is  obvious  to  all  that  adequate  numbers 
of  young  general  practitioners  required  to 
replace  our  rapidly  retiring  older  family 
physicians  are  just  not  going  to  be  available. 

If  we  are  going  to  discharge  the  resjDon- 
sibilities  as  guardians  of  the  public  health 
then  we  must  be  realistic  and  adopt  tech- 
nical changes  in  the  delivery  of  health  care 
that  will  permit  us  to  do  the  job. 


for  July,  1970 


Newsreel  Classics 

By  M.  W.  Martin/Ohio 

“The  death  of  the  patient  terminates  the 
physician-patient  relationship.” 

Ohio  State  Medical  Journal 
"First  draft  call  for  sex  comes  to  women 
doctors.” 

Russellville  Courier-Deinocrat 
“As  to  the  heart  condition,  a result  of  the 
accident,  Dr.  Stahl  stated  that  while  she 
will  probably  always  have  this  ailment,  it 
will  not,  in  his  opinion,  always  be  perman- 
ent.” 

Hut  ch  i ns  on  Neivs-Herald 
“Mr.  Ringling  eats  sparingly;  smokes  de- 
nicotinized  cigars,  takes  daily  exercises  and 
until  the  beginning  of  this  illness  was  able 
to  touch  the  floor  with  his  finger  tips  with- 
out bending.” 

New  York  Times 
“ ‘But,’  Dr.  Harrison  says,  ‘we’re  happy 
to  get  cadavers  at  any  price  and  we’ll  settle 
for  a change  in  legislature  that  will  help  to 
maintain  an  adequate  supply.’  ” 

Norway  Advertiser 
“William  Sorensen  returned  home  yes- 
terday from  the  hospital,  where  his  left  leg 
was  placed  in  a cast  following  a fracture  of 
the  right  ankle.” 

Auburn  Star 

“I’he  bandits  demanded  heavy  ransom 
for  their  release,  threatening  to  cut  off  their 
heads  and  then  put  them  to  death  if  the 
money  was  not  forthcoming.” 

T oledo  Blade 

“I'he  district  has  no  figures  as  to  the 
number  of  married  students  who  are  preg- 
nant. Almost  all  of  them  are  girls.” 

Jackson  State  Times 
“Miami  man  admits  taking  his  own  life.” 

Oakland  Tribune 
“His  face  still  patched  with  adhesive 
plaster,  Winston  Churchill  today  was  taken 
to  the  Waldorf  Astoria  Hotel  and  was  im- 
mediately put  to  bed  under  his  nurse  and 
with  his  wife  and  daughter.” 

Genesee  Livingston-Republican 
“A  sixty-five-year-old  male  with  proven 
eosinophilic  gastroenteritis  was  followed 
for  nearly  seven  years.” 

JAMA 

“City  youths  brought  to  county  jail  fol- 
lowing post-mortem  statement  of  dead 
bandit.” 

Chicago  Tribune 

12 


Brief  Summary  of  Prescribing  Information— 

9-9/22/69.  For  complete  information  consult 
Official  Package  Circular. 

Indications:  Essential  hypertension.  Use  cau- 
tiously in  patients  with  renal  insufficiency, 
particularly  if  they  are  digitalized. 
Contraindications:  Anuria,  oliguria,  active 
peptic  ulceration,  ulcerative  colitis,  severe  de- 
pression or  hypersensitivity  to  its  components 
contraindicates  the  use  of  Salutensin. 
Warnings:  Small-bowel  lesions  (obstruction, 
hemorrhage,  perforation  and  death)  have 
occurred  during  therapy  with  enteric-coated 
formulations  containing  potassium,  with  or 
without  thiazides.  Such  potassium  formula- 
tions should  be  used  with  Salutensin  only 
when  indicated  and  should  be  discontinued 
immediately  if  abdominal  pain,  distension, 
nausea,  vomiting  or  gastrointestinal  bleeding 
occurs.  Use  cautiously,  and  only  when  deemed 
essential,  in  fertile,  pregnant  or  lactating  pa- 
tients. Use  in  Pregnancy:  Thiazides  cross  the 
placenta  and  can  cause  fetal  or  neonatal 
hyperbilirubinemia,  thrombocytopenia, 
altered  carbohydrate  metabolism  and  possibly 
electrolyte  disturbances.  Fatal  reactions  may 
occur  with  reserpine  during  electroshock 
therapy;  discontinue  Salutensin  2 weeks  be- 
fore such  therapy.  Increased  respiratory 
secretions,  nasal  congestion,  cyanosis  and 
anorexia  may  occur  in  infants  born  to  reser- 
pine-treated  mothers. 

Precautions:  Azotemia,  hypochloremia,  hypo- 
natremia, hypochloremic  dkalosis  and  hypo- 
kaliemia  (especially  with  hepatic  cirrhosis 
and  corticosteroid  therapy)  may  occur,  par- 
ticularly with  pre-existing  vomiting  and  diar- 
rhea. Potassium  loss  or  protoveratrine  A may 
cause  digitalis  intoxication.  Potassium  loss 
responds  to  potassium-rich  foods,  potassium 
chloride  or,  if  necessary,  discontinuation  of 
therapy.  Stop  therapy  if  protoveratrine  A 
induces  digitalis  intoxication.  Serum  am- 
monia elevation  may  precipitate  coma  in 
precomatose  hepatic  cirrhotics.  Discontinue 
therapy  2 weeks  before  surgery  or  if  myo- 
cardial irritability,  progressive  azotemia  or 
severe  depression  occur.  Exercise  caution  in 
patients  with  chronic  uremia,  angina  pec- 
toris, coronary  thrombosis  or  extensive  cere- 
bral vascular  disease  or  bronchial  asthma  and 
in  those  with  a history  of  peptic  ulceration  or 
bronchial  asthma;  in  post-sympathectomy  pa- 
tients; in  patients  on  quinidine;  and  in  pa- 
tients with  gallstones,  in  whom  biliary  colic 
may  occur.  Patients  who  have  diabetes 
mellitus  or  who  are  suspected  of  being  pre- 
diabetic should  be  kept  under  close  observa- 
tion if  treated  with  this  agent. 

Adverse  Reactions:  Hydroflumethiazide;  Skin 
rashes  (including  exfoliative  dermatitis),  skin 
photosensitivity,  urticaria,  necrotizing  angiitis, 
xanthopsia,  granulocytopenia,  aplastic 
anemia,  orthostatic  hypotension  (potentiated 
with  alcohol,  barbiturates  or  narcotics),  aller- 
gic glomerulonephritis,  acute  pancreatitis, 
liver  involvement  (intrahepatic  cholestatic 
jaundice),  purpura  plus  or  minus  throm- 
bocytopenia, hyperuricemia,  hyperglycemia, 
glycosuria,  malaise,  weakness,  dizziness,  fa- 
tigue, paresthesias,  muscle  cramps,  skin  rash, 
epigastric  distress,  vomiting,  diarrhea  and 
constipation.  Reserpine:  Depression,  peptic 
ulceration,  diarrhea.  Parkinsonism,  nasal  stuf- 
finess, dryness  of  the  mouth,  weight  gain, 
impotence  or  decreased  libido,  conjunctival 
injection,  dull  sensorium,  deafness,  glaucoma, 
uveitis,  optic  atrophy,  and,  with  overdosage, 
agitation,  insomnia  and  nightmares.  Proto- 
veratrine A:  Nausea,  vomiting,  cardiac  ar- 
rhythmia, prostration,  blurring  vision,  mental 
confusion,  excessive  hypotension  and  brady- 
cardia. (Treat  bradycardia  with  atropine  and 
hypotension  with  vasopressors.) 

Usual  Dose:  1 tablet  b.i.d. 

Supplied:  Bottles  of  60,  600,  and  1000  scored 
50  mg.  tablets. 

Salutensin' 

hydroflumethiazide,  50  mg./ reserpine, 
0.125  mg.  protoveratrine  A,  0.2  mg. 

BRISTOL  LABORATORIES 
Division  of  Bristol-Myers  Company 
Syracuse,  New  York  13201 


BRISTOL 


ther  days  she  doesn't  even  try 

I the  treatment  of  depression,  Aventyl  HCI  as  part  of  your  total 
srapy  often  brings  early  symptomatic  improvement, 
entyl  HCI  aids  in  renewing  motor  function  and  increasing 
erest  in  life.  Patients  may  report  that  they  eat  more,  enjoy 
idisturbed  sleep  . , . generally  begin  to  function  better.  Relief 
m their  most  distressing  symptoms  helps  them  “open  up” 
id  ventilate  their  problems. 


|i  depression 


^VtNTYL'  HCI 

ORTRIPTYLINE  HVDROCHLORIDE 


lations;  Aventyl  HCI  is  indicated  for  the  relief  of 
toms  of  depression.  Endogenous  depressions  are  more 
to  be  alleviated  than  are  other  depressive  states. 

raindications:  The  use  of  Aventyl  HCI  or  other  tri- 
antidepressants concurrently  with  a monoamineoxi- 
(M  AO)  inhibitor  is  contraindicated.  Hyperpyretic  crises, 
e convulsions,  and  fatalities  have  occurred  when  simi- 
cyclic  antidepressants  were  used  in  such  combinations, 
ntinue  the  MAO  inhibitor  for  at  least  two  weeks  before 
jnent  with  Aventyl  HCI.  Patients  hypersensitive  to 
ityl  HCI  should  not  be  given  the  drug. 

3ss-sensitivity  between  Aventyl  HCI  and  other  diben- 
lines  is  a possibility. 

entyl  HCI  is  contraindicated  during  the  acute  recovery 
ti  after  myocardial  infarction. 

jings:  Cardiovascular  patients  should  be  supervised 
ly  because  of  the  tendency  of  Aventyl  HCI  to  produce 
i tachycardia  and  to  prolong  the  conduction  time, 
ardial  infarction,  arrhythmia,  and  strokes  have  oc- 
d.  The  antihypertensive  action  of  guanethidine  and 
ar  agents  may  be  blocked.  Because  of  its  anticholinergic 
ity,  Aventyl  HCI  should  be  used  with  great  caution  in 
nts  with  glaucoma  or  a history  of  urinary  retention, 
nts  with  a history  of  seizures  should  be  followed 
ly,  since  this  drug  is  known  to  lower  the  convulsive 
hold.  Great  care  is  required  if  Aventyl  HCI  is  admin- 
;d  to  hyperthyroid  patients  or  to  those  receiving  thy- 
medication,  since  cardiac  arrhythmias  may  develop. 
;age  in  Pregnancy — Safe  use  of  Aventyl  HCI 
ig  pregnancy  and  lactation  has  not  been  established; 
Tore,  the  potential  benefits  of  administration  to  preg- 
patients,  nursing  mothers,  or  women  of  childbearing 
itial  must  be  weighed  against  the  possible  hazards, 
rage  in  Children— l'n\%  drug  is  not  recommended 
ise  in  children,  since  safety  and  effectiveness  in  the 
itric  age  group  have  not  been  established, 
entyl  HCI  may  impair  the  mental  and/or  physical 
;ies  required  tor  the  performance  of  hazardous  tasks, 
as  operating  machinery  or  driving  a car;  therefore, 
latient  should  be  warned  accordingly. 

autions:  Aventyl  HCI  in  schizophrenic  patients  may 
t in  an  exacerbation  of  the  psychosis  or  may  activate 
t schizophrenic  symptoms.  In  overactive  or  agitated 
nts,  increased  anxiety  and  agitation  may  occur.  In 
c-depressive  patients,  Aventyl  HCI  may  cause  symp- 
of  the  manic  phase  to  emerge, 
oublesome  patient  hostility  may  be  aroused  by  the  use 
ventyl  HCI.  Epileptiform  seizures  may  accompany  its 
inistration,  as  is  true  of  other  drugs  of  its  class. 


Close  supervision  and  careful  adjustment  of  the  dosage 
are  required  when  Aventyl  HCI  is  used  with  other  anti- 
cholinergic drugs  and  sympathomimetic  drugs. 

The  patient  should  be  informed  that  the  response  to 
alcohol  may  be  exaggerated. 

When  necessary,  the  drug  may  be  administered  with 
electroconvulsive  therapy,  although  the  hazards  may  be 
increased.  Discontinue  the  drug  for  several  days,  if  possible, 
prior  to  elective  surgery. 

Because  the  possibility  of  a suicidal  attempt  by  depressed 
patients  remains  after  the  initiation  of  treatment,  dispense 
the  least  possible  quantity  of  drug  at  any  given  time. 

Both  elevation  and  lowering  of  blood  sugar  levels  have 
been  reported. 

Adverse  Reactions:  Note;  Included  in  the  following  list 
are  a few  adverse  reactions  which  have  not  been  reported 
with  this  specific  drug.  However,  the  pharmacologic  simi- 
larities among  the  tricyclic  antidepressant  drugs  require 
that  each  of  the  reactions  be  considered  when  nortriptyline 
is  administered. 

Carc//ovascu/ar— Hypotension,  hypertension,  tachycar- 
dia, palpitation,  myocardial  infarction,  arrhythmias,  heart 
block,  stroke. 

Psycfi/afr/c— Confusional  states  (especially  in  the 
elderly)  with  hallucinations,  disorientation,  delusions;  anx- 
iety, restlessness,  agitation;  insomnia,  panic,  and  night- 
mares; hypomania;  exacerbation  of  psychosis. 

A/euro/og/ca/— Numbness,  tingling,  paresthesias  of 
extremities;  in-co-ordination,  ataxia,  tremors;  peripheral 
neuropathy;  extrapyramidal  symptoms;  seizures,  alteration 
in  EEG  patterns;  tinnitus. 

Anticholinergic— Diy  mouth  and,  rarely,  associated 
sublingual  adenitis;  blurred  vision,  disturbance  of  accom- 
modation, mydriasis;  constipation,  paralytic  ileus;  urinary 
retention,  delayed  micturition,  dilation  of  the  urinary  tract. 

Allergic— SWin  rash,  petechiae,  urticaria,  itching,  photo- 
sensitization (avoid  excessive  exposure  to  sunlight);  edema 
(general  or  of  face  and  tongue),  drug  fever,  cross-sensitivity 
with  other  tricyclic  drugs. 

Hemafo/og/c— Bone-marrow  depression,  including 
agranulocytosis;  eosinophilia;  purpura;  thrombocytopenia. 

Gastro-Intestinal— Nausea  and  vomiting,  anorexia, 
epigastric  distress,  diarrhea;  peculiar  taste,  stomatitis,  ab- 
dominal cramps,  blacktongue. 

Endocrine— Gynecomastia  in  the  male;  breast  enlarge- 
ment and  galactorrhea  in  the  female;  increased  or  de- 
creased libido,  impotence;  testicular  swelling;  elevation  or 
depression  of  blood  sugar  levels. 

Of/ier— Jaundice  (simulating  obstructive);  altered  liver 
function ; weight  gain  or  loss;  perspiration ; flushing;  urinary 


Additional  information  available  upon  request. 

ELI  LILLY  AND  COMPANY*  INDIANAPOLIS,  INDIANA  46206 


frequency,  nocturia;  drowsiness,  dizziness,  weakness,  and 
fatigue;  headache;  parotid  swelling;  alopecia. 

Withdrawal  Symptoms— Though  these  are  not  indic- 
ative of  addiction,  abrupt  cessation  of  treatment  after  pro- 
longed therapy  may  produce  nausea,  headache,  and  malaise. 

Administration  and  Dosage:  Aventyl  HCI  is  not  recom- 
mended for  children. 

Aventyl  HCI  is  administered  orally  in  the  form  of  Pul- 
vules®  or  liquid.  Lower  dosages  are  recommended  for 
elderly  patients,  adolescents,  and  outpatients  not  under 
close  supervision.  .Start  dosage  at  a low  level  and  increase 
gradually,  noting  carefully  the  clinical  response  and  any 
evidence  of  intolerance.  Eollowing  remission,  maintenance 
medication  may  be  required  for  a prolonged  period  at  the 
lowest  effective  dose. 

If  a patient  develops  minor  side-effects,  reduce  the 
dosage.  Discontinue  the  drug  promptly  if  serious  adverse 
effects  or  allergic  manifestations  occur. 

Usual  Adult  Dose— 25  mg.  three  or  four  times  daily, 
starting  at  a low  level  and  increasing  as  required.  Doses 
above  100  mg.  per  day  are  not  recommended. 

Elderly  and  Adolescent  Patients— 20  to  50  mg.  per 
day,  in  divided  doses. 

Overdosage:  Toxic  overdosage  may  result  in  confusion, 
restlessness,  agitation,  vomiting,  hyperpyrexia,  muscle 
rigidity,  hyperactive  reflexes,  tachycardia,  EGG  evidence  of 
impaired  conduction,  shock,  congestive  heart  failure,  stupor, 
coma,  and  C.N.S.  stimulation  with  convulsions  followed  by 
respiratory  depression.  Deaths  have  occurred  following 
overdosage  with  drugs  of  this  class. 

No  specific  antidote  is  known.  General  supportive  meas- 
ures are  indicated,  with  gastric  lavage.  Respiratory  assist- 
ance is  apparently  the  most  effective  measure  when  indi- 
cated. The  use  of  C.N.S.  depressants  may  worsen  the 
prognosis. 

Barbiturates  for  control  of  convulsions  alleviate  an  in- 
crease in  the  cardiac  work  load  but  should  be  used  with 
caution  to  avoid  potentiation  of  respiratory  depression. 

Intramuscular  paraldehyde  or,  preferably,  diazepam  pro- 
vides anticonvulsant  activity  with  less  respiratory  depres- 
sion than  do  the  barbiturates. 

Digitalis  and/or  pyridostigmine  may  be  considered  in 
serious  cardiovascular  abnormalities  or  cardiac  failure. 

The  value  of  dialysis  has  not  been  established. 

How  Supplied:  Liquid  Aventyl®  HCI  (nortriptyline  hydro- 
chloride, Lilly),  10  mg.  (equivalent  to  base)  per  5 ml.,  in 
pint  bottles. 

Pulvules  Aventyl  HCI,  10  and  25  mg.  (equivalent  to  base), 
in  bottles  of  100  and  500.  [040670] 


Clinics  for  Crippled 

I'wenty  clinics  lor  Illinois’  physically 
handicapped  children  have  been  schednled 
for  August  by  the  University  of  Illinois, 
Division  of  Services  lor  Crippled  Children. 
The  Division  will  hold  14  general  clinics 
provitling  diagnostic  orthopedic,  pediatric, 
speech  and  hearing  examinations  along 
with  medical  social,  and  nursing  service. 
There  will  be  hve  sjrecial  clinics  lor  chil- 
dren with  cardiac  conditions  and  rheumatit 
level,  and  one  for  children  with  cerebral 
palsy.  Clinicians  are  selected  from  among 
private  physicians  who  are  certihed  Board 
members.  Any  private  physician  may  refer 
to  or  liring  to  a convenient  clinic  any  child 
or  children  for  whom  he  may  want  exami 
nation  or  consultative  services. 

.Vugust  5— Carlinville— Carlinville  Area 
Hospital 

.Vugust  5— Hinsdale— Hinsdale  Sanitarium 
Vugust  (i— Lake  County  Cardiac— V^ictory 
Memorial  Hospital 

Vugust  I I —Peoria— St.  Francis  Cihildrcn’s 
Hosjtital 

Vugust  II— East  St.  Louis— C;hristian  Wel- 
fare Hosjrital 

.Vugust  1 2— Champa ign-Urbana— McKinley 
Hospital 

.Vugust  I 3— Springfield  General— St.  John’s 
Hosjjital 

.Vugust  14— Chicago  Heights  Cardiac— St. 
fames  Hospital 

■ Vugust  1 8— Belleville— St.  Elizabeth’s  Hos- 

pital 

Vugust  18— Rock  Island  Area  General- Mo- 
line Public  Hosjjital 

■ Vugust  19— Chicago  Heights  General- St. 

James  Hospital 


Children  Scheduled 

Auaiist  20— Rockford— Rockford  Memoiial 
Hospital 

August  20— Bloomington— St.  Joseph’s  Hos- 
pital 

August  20— Elndunst  Cardiac  — Memorial 
Hospital  of  DuPage  County 
August  24— Peoria  C a r d i a c— St.  Francis 
Children’s  Hospital 

August  25— Peoria— St.  Francis  Children’s 

o 

Hospital 

August  26— Aurora— Co|)ley  Memorial  Flos- 
pital 

■ Vugust  26— Springfield  Pediatric  Neurology 

—Diocesan  Center 

■Vugust  28— Chicago  Heights  Cardiac— St. 
James  Hospital 

■ Vugust  28— Evanston— St.  Erancis  Hos]htal 

The  Division  of  Services  lor  Crippled 
Children  is  the  official  state  agency  estafi- 
lishcd  to  pros  ide  medical,  surgical,  correc- 
tive, ami  other  .services  and  facilities  for 
diagnosis,  hospitalization  and  alter-care  for 
children  with  crippling  conditions  or  svho 
are  suflering  from  conditions  th;it  may  lead 
to  crippling. 

In  carrying  on  its  program,  the  Division 
works  cooperatively  with  local  medical  so- 
cieties, hospitals,  the  Illinois  Children’s  Hos- 
pital-School,  civic  anti  Iraternal  clubs,  visit- 
ing nurse  tissociation,  local  social  and  svel- 
fare  agencies,  local  chapters  of  the  National 
Foundation  and  other  interestetl  groups.  In 
all  cases,  the  work  of  the  Division  is  intend- 
ed to  extend  and  supplement,  not  supplant 
activities  of  other  agencies,  either  public  or 
private,  state  or  local,  carried  on  in  behalf 
of  crip|jled  children. 


ON  THE  COVER 

The  expansion  of  medicine  in  terms  of  health  care  and  knowledge  is  expressed  in  the  bril- 
liant colors  surrounding  the  caduceus,  which  like  the  rays  of  the  sun  appear  to  be  far-reaching, 
blending  into  the  unknown. 

The  caduceus  long  recognized  as  the  symbol  of  medicine  consists  of  a staff  of  Aesculapius 
about  which  a single  serpent  is  coiled. 

The  Medical  Corps  of  the  United  States  Army  has  modified  the  symbol  to  consist  of  a staff 
with  two  formal  wings  at  the  top,  and  two  separate  serpents  entwined  about  the  remainder. 
The  latter  is  not  regarded  as  a medical,  but  as  an  administrative  emblem,  implying  neutral, 
non-combatant  status. 


16 


Illinois  Medical  Journal 


Abstracts  Of  Board  Actions 

Board  of  Trustees  Meeting  During  Annual  Convention 
May  16-20,  1970 
Sherman  House  Hotel,  Chicago 

These  abstracts  are  published  so  that  rnembers  of  the  Illinois  State  Medical  Society  may 
keep  advised  of  the  actions  of  the  Board  of  Trustees.  It  covers  only  major  actions  and  is 
not  intended  as  a detailed  report.  Full  minutes  of  the  meetings  are  available  upon  any 
member’s  request  to  the  headquarters  office  of  the  ISMS. 

Agreement  with  Third  Party  Carrier 

Progress  was  reported  by  Dr.  Edward  Cannady  in  discussions 
with  the  Continental  Casualty  Company,  regarding  administration 
of  Part  B Medicare  in  97  Illinois  counties.  The  following  agree- 
ments have  been  reached: 

Inconsistencies  of  charges  will  be  examined  by  the 
company  and  elimination  of  coding  inconsistencies 
will  be  accomplished  ; form  letters  written  to  pa- 
tients by  the  firm  will  be  discussed  with  ISMS  to 
eliminate  obnoxious  phrases ; telephone  calls  to 
physicians  will  be  curtailed  as  much  as  possible  ; 
physicians  will  be  given  opportunity  to  justify 
questioned  bills. 

Continuing  Medical  Education 

Previous  action  of  the  Board  of  Trustees,  requesting  the 
House  of  Delegates  to  authorize  a $20  per  member  dues  assessment 
in  support  of  the  continuing  medical  education  program,  was  re- 
considered. The  action  was  based  on  information  from  Dr.  George 
Miller,  University  of  Illinois,  that  other  medical  schools 
would  not  be  participants  and  that  the  program  will  largely  be 
conducted  by  the  University  of  Illinois.  The  Board  will  recom- 
mend, to  the  House  of  Delegates,  enthusiastic  support  of  the 
program,  with  ISMS  participation,  but  financial  support  from 
ISMS  will  be  deferred  until  a later  date. 

IMPAC  Membership  Records 

The  report  of  the  treasurer  showed  that  dues  paying  members 
recorded  for  the  first  quarter  of  1970  totaled  8,304.  Of  these 
members,  44%  had  become  contributors  to  IMPAC  on  a voluntary 
basis.  The  IMPAC  3rd  District  percentage  was  36%  and  the  re- 
mainder of  the  state  62%  of  the  paid  membership.  The  anticipated 
total  paid  members  of  the  ISMS  for  the  year  is  9,350.  Retired, 
emeritus  and  other  categories  will  increase  the  total  membership 
to  about  10,500. 

Meeting  with  Illinois  Hospital  Association 

At  a meeting  between  the  Executive  Committees  of  the  ISMS  and 
IHA  it  was  agreed — 

•to  jointly  update  a handbook  on  the  release  of  medi- 
cal records  previously  published  by  the  Illinois 
Medical  Records  Librarian  Association 
•to  send  a joint  letter  to  hospitals,  E.C.F.'s  and 

ly 


for  July,  1970 


nursing  homes  regarding  the  proper  use  of  physical 
therapy  services 

©to  jointly  study  ways  of  reducing  malpractice  cases 
•that  IHA  Executive  Committee  would  distribute  a 
letter  to  hospitals  stating  the  Association's  of- 
ficial position  on  physicians  serving  on  hospital 
boards 

• that  the  ISMS  would  keep  the  IHA  informed  of  new  de- 
velopments in  the  use  of  physicians'  assistants 

CMS  Funds  for  Benevolence  Core 

All  recipients  of  ISMS  benevolence  from  the  3rd  District  will 
be  paid  from  a fund  at  CMS,  established  at  the  bequest  of  one  of 
the  past  presidents  of  the  State  Society  Auxiliary.  This  pro- 
cedure will  be  followed  after  July  1,  1970,  and  continue  as  long 
as  funds  are  available  from  this  source.  Payments  to  most  of  the 
benevolence  recipients  will  be  increased  effective  July  1,  1970. 

School  Bus  Driver  Physicals 

Many  school  districts,  under  existing  local  option,  do  not 
require  physical  examinations  for  school  bus  drivers.  The  Board 
acted  to  refer  this  matter  to  the  Committee  on  Public  Safety  for 
study  and  recommendations  for  subsequent  action. 

Peer  Review  Guidelines 

The  Board  reviewed  further  refinements  made  in  the  Peer  Re- 
\ iew  Guidelines  by  the  interim  peer  review  committee.  Several 
changes  in  wording  were  suggested.  The  Guidelines  will  be  pub- 
lished in  final  form  and  be  distributed  to  county  societies  for 
their  advice  and  guidance. 

Annual  Illinois  Luncheon  Cancelled 

The  ISMS  will  participate  in  honoring  Dr.  Walter  C.  Bornemeier 
as  the  in-coming  President  of  the  American  Medical  Association. 
The  funds  usually  expended  on  the  Illinois  luncheon  at  the  AMA 
meeting  will  be  made  available  to  assist  in  hosting  the  recep- 
tion honoring  Dr.  Bornemeier  on  Wednesday  evening,  June  24. 
The  reception  will  follow  the  inaugural  services. 

New  Chairman  of  the  Board  Elected 

At  the  post-convention  Board  meeting.  Dr.  Willard  C.  Scrivner, 
East  St.  Louis,  was  selected  to  follow  Dr.  Frank  J.  Jirka,  Jr., 
River  Forest,  as  Chairman  of  the  Board.  Dr.  Edward  W.  Cannady, 
immediate  past  president  was  named  to  serve  as  Parliamentarian 
for  the  Board  of  Trustees. 

Computerized  Billing  Service  Approved 

Upon  recommendation  of  the  Council  on  Economics  and  Govern- 
mental Health  Programs,  the  computerized  billing  system  for 
physicians,  developed  by  Indecon,  a Chicago  based  firm,  was  en- 
dorsed. Physicians  who  subscribe  to  this  service  will  be  invited 
to  share  fee  data  with  the  Council  on  Peer  Review.  Indecon  is 
headed  by  Mr.  William  Love,  formerly  associated  with  Blue  Shield. 

(CoJitimwd  on  pnge  86) 


20 


Illinois  Medical  Journal 


^chrocidin  Tablets  and  Syrup 


etracycline  HCl— Antihistamine— Analgesic  Compound 

ach  tablet  contains:  ACHROMYCIN®  Tetracycline  HCl  125  mg.;  Phenacetin  120  mg.;  Caffeine  30  mg.;  Salicylamide  150  mg.;  Chlorothen  Citrate  25  mg. 


CHROCIDIN  Tetracycline  HCl— Antihistamine— Analgesic  Compound  Tablets  and  Syrup  are  recommended  for  the  treatment 
P tetracycline-sensitive  bacterial  infection  vyhich  may  complicate  vasomotor  rhinitis,  sinusitis  and  other  allergic  diseases  of  the 
pper  respiratory  tract,  and  for  the  concomitant  symptomatic  relief  of  headache  and  nasal  congestion.  For  children  and  elderly 
atients  you  may  prefer  caffeine-free  ACHROCIDIN  Syrup.  Each  5 cc  contains:  ACHROMYCIN  Tetracycline  equivalent  to 
etracycline  HCl  125  mg.;  Phenacetin  120  mg.;  Salicylamide  150  mg.;  Ascorbic  Acid  (C)  25  mg.;  Pyrilamine  Maleate  15  mg. 


onlraindications:  Hypersensitivity  to  any 
imponent. 

'arning:  In  renal  impairment,  since  liver  tox- 
ity  is  possible,  lower  doses  are  indicated;  dur- 
ig  prolonged  therapy  consider  serum  level 
terminations.  Photodynamic  reaction  to  sun- 
ght  may  occur  in  hypersensitive  persons, 
iiotosensitive  individuals  should  avoid  expo- 
ire;  discontinue  treatment  if  skin  discomfort 
:curs. 

recautions:  Drowsiness,  anorexia,  slight  gas- 
ic  distress  can  occur.  In  excessive  drowsi- 
:ss,  consider  longer  dosage  intervals.  Persons 


on  full  dosage  should  not  operate  vehicles. 
Nonsusceptible  organisms  may  overgrow;  treat 
superinfection  appropriately.  Treat  beta- 
hemolytic  streptococcal  infections  at  least  10 
days  to  help  prevent  rheumatic  fever  or  acute 
glomerulonephritis.  Tetracycline  may  form  a 
stable  calcium  complex  in  bone-forming  tissue 
and  may  cause  dental  staining  during  tooth 
development  (last  half  of  pregnancy,  neonatal 
period,  infancy,  early  childhood). 

Adverse  Reactions:  Gastrointestinal— anore'x.ia, 
nausea,  vomiting,  diarrhea,  stomatitis,  glossi- 
tis, enterocolitis,  pruritus  ani.  5km— maculo- 


papular  and  erythematous  rashes;  exfoliative 
dermatitis;  photosensitivity;  onycholysis,  nail 
discoloration.  dose-related  rise  in 

BUN.  Hypersensitivity  reactions— unicatia, 
angioneurotic  edema,  anaphylaxis.  Intracranial 
—bulging  fontanels  in  young  infants.  Teeth— 
yellow-brown  staining;  enamel  hypoplasia. 
B/ooif— anemia,  thrombocytopenic  purpura, 
neutropenia,  eosinophilia.  Liver- cholestasis  at 
high  dosage. 

Upon  adverse  reaction,  stop  medication  and 
treat  appropriately. 


LEDERLE  LABORATORIES,  A Division  of  American  Cyanamid  Company,  Pearl  River,  New  York  10965 


534-9 


NEW 

PHARMACEUTICAL 

SPECIALTIES 

by  Paul  deHaen 

For  detailed  information  regarding  indica- 
tions, dosage,  contraindications,  and  adverse 
reactions,  refer  to  the  manufacturer’s  package 
insert  or  brochure. 

Single  Chemicals:  Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products:  Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products:  Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms:  Of  a previously  introduced 
product. 

A New  Drug  Application  has  been  granted  by 
the  U.S.  Food  and  Drug  Administration  for 
the  following  new  drugs. 

CORTROSYN  Hormones-Corticoids 

Manufacturer:  Organon 

Nonproprietary  Name:  Cosyntropin  (USAN) 

DALMANE  Sedative  & Hypnotic-Nonbarbiturate 

Manufacturer:  Roche 

Nonproprietary  Name:  Flurazepam  HCl 

MIRTHRACIN  Cancer  Chemotherapy 
Manufacturer:  Pfizer 

Nonproprietary  Name:  Mirthramycin  (USAN) 
The  following  new  drugs  have  been  marketed: 

NEW  SINGLE  CHEMICALS 
ESKALITH 

Manufacturer:  Smith  Kline  & French 
LITHANE 

Manufacturer:  Roerig,  Div.  Pfizer 

LITHONATE 

Manufacturer:  Rowell 

Nonproprietary  Name:  Lithium  carbonate:  Ata- 
raxic,  Psychostimulant  R 

Indications:  Control  of  manic  episodes  in  manic 
depressive  psychosis. 

Contraindications:  Significant  cardiovascular  or 
renal  disease,  or  evidence  of  brain  damage.  Do 
not  administer  to  children  under  12. 

Dosage:  Acute  mania:  600  mg.  t.i.d.;  long  term: 
300  mg.  t.i.d.  Individualize  according  to  serum 
levels  and  clinical  response. 

Supplied:  Capsules  or  tablets,  300  mg. 

KETAJECT 
Manufacturer:  Bristol 
KETALAR 

Manufacturer:  Parke,  Davis  (Originator) 
Nonproprietary  Name:  Ketamine  HCl:  Anestbe- 
tic-Injectable  R 

Indications:  Sole  short  acting  anesthetic  agent 
for  diagnostic  and  surgical  procedures.  Can  be 
extended  for  periods  of  six  hours  or  longer. 
Contraindications:  History  of  cerebrovascular  ac- 
cident or  hypersensitivity  to  the  drug. 

Dosage:  Individualized  according  to  patient’s  re- 
quirements. 

Supplied:  Vials,  20  cc  containing  10  mg.  base/cc 
50  cc  containing  10  mg.  base/cc 
10  cc  containing  50  mg.  base/cc 


NEW  INDICATION 

Xylocaine  Antiarrhythmic  R 

Manufacturer:  Astra 

Nonproprietary  Name:  Lidocaine  (USAN) 
Indications:  Acute  and  life-threatening  arrhyth- 
mias. 

Contraindications:  Hypersensitivity  to  local  anes- 
thetics of  the  amide  type.  Adams-Stokes  syn- 
drome and  severe  degrees  of  sinoatrial,  atrio- 
ventricular or  intraventricular  block. 

Dosage:  Usual  dose:  50-100  mg.  intravenously 
under  ECG  monitoring  administered  at  ap- 
proximately 25-50  mg. /min. 

Supplied:  Single  dose  ampules  of  2%  solution,  5 
and  50  cc.  Special  package  for  arrhythmias. 

DUPLICATE  SINGLE  PRODUCTS 
CENDEVAX  Biological  R 

Manufacturer:  Recherche  et  Industrie  Therapeu- 
tiques,  subsidiary  of  Smith  Kline  & French 
Nonproprietary  Name:  Rubella  virus  vaccine, 
live  (Cendehill  Strain) 

Indications:  Immunization  against  German  meas- 
les. 

Contraindications:  Febrile  illness,  leukemia, 

lymphoma,  generalized  malignancy  or  lowered 
resistance  due  to  therapy  with  corticosteroids, 
alkylating  drugs,  antimetabolites  or  radiation. 
Hypersensitivity  to  rabbits  or  neomycin.  Do  not 
administer  to  pregnant  women. 

Dosage:  Injection,  s.c.  only — 0.5  cc. 

Supplied:  Vials,  single  dose. 

ETHAQUIN  Vasodilators-Peripheral  R 

Manufacturer:  Ascher 
Nonproprietary  Name:  Ethaverine  HCl 
Indications:  Peripheral  and  cerebral  vascular  in- 
sufficiency associated  with  arterial  spasm; 
smooth  muscle  spasmolytic  in  spastic  condi- 
tions of  the  G.I.  and  G.U.  tract. 
Contraindications:  Presence  of  complete  atrio- 
ventricular dissociation. 

Dosage:  1 tablet  t.i.d. 

Supplied:  Tablets,  100  mg. 

FEMINONE  Estrogen  R 

Manufacturer:  Upjohn 
Nonproprietary  Name:  Ethinyl  estradiol 
Indications:  Hypoestrogenic  states. 
Contraindications:  Known  or  suspected  malig- 
nancy of  breast  or  genital  organs.  Undiagnosed 
vaginal  bleeding.  Liver  dysfunction  or  disease. 
Thrombophlebitis  or  history  of  thrombophle- 
bitis or  pulmonary  embolism.  History  of  cere- 
brovascular accident. 

Dosage:  Individualized.  Va  to  3 tablets  t.i.d. 
Supplied:  Tablets,  0.05  mg. 

OXY-KESSO-TETRA  Antibiotic  R 

Manufacturer:  McKesson,  Div.  Formost-McKes- 
son 

Nonproprietary  Name:  Oxytetracycline  HCl 
Indications:  Variety  of  systemic  infections,  cer- 
tain infections  of  the  respiratory  tract,  skin 
and  soft  tissues,  gastrointestinal  and  genito- 
urinary tract,  due  to  susceptible  organisms. 
Contraindications:  Hypersensitivity  to  tetracy- 
cline. 

Dosage:  Adults:  250-500  mg.  q.i.d. 

Children:  As  per  instructions. 

Supplied:  Tablets,  250  mg. 

SOSOL  Sulfonamides  R 

Manufacturer:  McKesson,  Div.  Foremost-McKes- 
son 

Nonproprietary  Name:  Sulfisoxazole 

(Contimied  on  page  42) 


26 


Illinois  Medical  Journal 


ILLINOIS 

MEDICAL 

ASSISTANTS 

ASSOCIATION 


REPORT 


Today’s  Challenge:  Medicine 


By  Thelma  Peplow/Sycamore 


Keeping  abreast  of  the  fast  pace  in  the 
new  and  ever-changing  field  of  medicine  is 
a challenge,  not  only  to  the  physician,  but 
also  to  the  medical  assistant.  In  this  age 
of  computers  and  other  new  diagnostic  and 
therapeutic  methods,  the  assistant  must  be 
able  to  cope  with  the  changing  times.  A 
program  of  continuing  education  is  the 
only  answer  in  enabling  us  to  meet  our 
daily  work  crises. 

The  Illinois  Medical  Assistants  Associa- 
tion’s aim  is  to  educate  its  members  so  they 
can  be  part  of  the  medical  team,  thereby 
improving  the  relationship  between  the 
physician,  patient  and  assistant.  Local  Medi- 
cal Assistant  Chapters  use  educational  lec- 
tures, films  and  panel  discussions  to  keep 
the  members  alert  to  the  many  problems 
with  which  they  may  be  confronted  in  their 
jobs.  These  programs  encompass  the  varied 
duties  of  the  medical  assistant,  such  as  col- 
lections, telephone  technique,  and  office 
and  clinical  procedures. 

The  sole  purpose  of  the  Medical  Assist- 
ants Association  is  to  continue  our  educa- 


tion by  reviewing  the  old  and  learning  the 
new.  Our  organization  is  a non-union,  non- 
profit association,  dedicated  to  better  serv- 
ice to  the  medical  profession  and  to  the 
public. 

To  have  an  alert  mind,  one  must  keep 
learning.  To  have  the  desire  to  learn,  one 
should  not  falter,  but  be  persistant  in  pur- 
suing the  opportunities  available.  Living 
in  our  modern  world  of  acceleration,  fur- 
ther education  is  a necessity.  Along  with 
improving  our  work,  we  can  also  learn  to 
understand  the  needs  of  our  fellowman. 
This  all  adds  not  only  to  the  education, 
but  also  to  the  dedication  of  the  Medical 
Assistant. 

If  your  assistant  is  interested  in  self  im- 
provement, she  may  contact: 

Mrs.  Norma  Domanic,  1st  Vice  President 
150  Ash  Street 
New  Lennox,  111.  60451 
or 

Mrs.  Vivian  Kraft,  2nd  Vice  President 
R.  R.  #2 

Normal,  111.  61761 


Meeting  Memos 


July  25-August  15 — Polytechnic  Insti- 
tute of  Brooklyn 

Three  week  summer  course  in  Research  Instrumen- 
tation 

333  Jay  Street,  Brooklyn,  New  York 

July  27-August  9 — U.S.  Department  of 
Health,  Education  and  Welfare 

Summer  Institute  in  Suicidology 

National  Institute  of  Mental  Health,  Washington, 

D.C. 

August  12-15 — The  American  Academy 
of  General  Practice 
Fourth  World  Conference  on  General  Practice 
Palmer  House  Hotel.  Chicago 
August  16-21 — American  Academy  of 
Physical  Medicine  and  Rehabilitation 
J2nd  Annual  Assembly 
New  York  Hilton,  New  York 
August  16-21 — American  Congress  of 


Rehabilitation  Medicine 

47th  Annual  Session 

New  York  Hilton,  New  York 

August  17-21 — Western  Institute  of 

Drug  Problems 

Third  Annual  Summer  School 

Portland  State  University,  Portland,  Oregon 

August  19-23— UCLA 

Advanced  Seminar  in  Urology 

Residential  Conference  Center,  Lake  Arrowhead, 

California 

August  20-22 — University  of  Wisconsin 

Ninth  National  Conference  on  Therapies  for  Ad- 
vanced Cancers 

University  of  Wisconsin,  Madison 

August  23-28 — International  Diabetes 
Federation 

7th  International  Congress  of  Diabetes 
Buenos  Aires,  Argentina 


for  July,  1970 


31 


Now 

available  for  your 
prescribing 


32 


Illinois  Medical  Journal 


Illinois  Medical  Journal 


volume  138,  number  1 


July,  1970 


Popliteal  Aneurysm: 

An  Unresolved  Problem 


By  Richard  C.  Powers^  M.D.,  F.A.C.S.,  and  Isa  Sejdinaj,  M.D.,  F.A.C.S./Elgin 


In  1918,  at  the  beginning  ol  the  era  ol 
direct  vascidar  surgery,  Linton^  reported 
100%  limb  survival  in  a series  ol  13  popli- 
teal aneurysms  treated  by  preliminary  lum- 
bar sympathectomy  lollowed  by  aneurys- 
mectomy. In  a review  of  the  literature,  the 
authors  were  unable  to  find  a comparably 
good  series  reported  since  that  time.  How- 
ever, careful  analysis  ol  this  frequently 
quoted  report  confirms  that  no  aneury,sm 
was  thrombosed  preojreratively  and  all  pa- 
tients had  at  least  one  intact  foot  pidse  at 
the  time  of  surgery.  As  recently  as  1966, 


Richard  C. 
Powers,  M.D, 
(left),  is  attend- 
ing surgeon  in 
vascular  surgery, 
Sherman  and  St. 
Joseph  Hospi- 
tals, Elgin.  He  is 
a graduate  of 
the  Northwest- 
ern University  Medical  School  and  served  his 
internship  in  Evanston  Hospital  and  a residency 
at  Hines  V.A.  Hospital.  Isa  Sejdinaj,  M.D. 
(right)  is  a graduate  of  the  University  of  Graz, 
Austria,  Medical  School.  He  also  is  attending 
surgeon  in  vascular  surgery  at  Sherman  and 
St.  Joseph  Hospitals. 


Baird-  reported  continuing  failure  with  the 
.surgical  treatment  of  thrombosed  popliteal 
aneurysm  and  that  “amputation  was  nece,s- 
sary  in  hall  of  the  thrombosed  aneurysms.” 
Janes'^  reviewed  100  cases  of  popliteal  an- 
eurysm in  1952,  treated  and  untreated,  and 
concluded  that  “it  is  debatable  whether 
there  is  anything  to  gain  by  operating  on 
a ]jopliteal  aneurysm  which  has  been  com- 
pletely occluded  by  a thrombus.”  I'his  con- 
clusion led  to  his  recommendation  that  sur- 
gical consideration  be  given  to  the  treat- 
ment of  popliteal  aneurysm  prior  to  de- 
velopment of  thrombosis.  A decade  later, 
1962,  the  same  author  reported  that  50% 
of  thrombosed  aneurysms  in  his  series  still 
resulted  in  amputation.  In  the  same  era 
DeBakey’s  group'’  and  Julian’s  groipF’  re- 
viewed similar  problems  in  their  series. 
Hara  and  Thompson’  reported  amputation 
ol  10  of  18  limbs  after  acute  occlusion,  in 
1966,  again  approximating  a 50%  limb-loss 
rate.  Our  personal  series,  treated  in  a com- 
munity hospital,  is  small,  but  further  em- 
phasizes that  thrombosis  of  popliteal  an- 
eurysm is  catastrophic. 

Case  Reports 

Case  1.  A 58-year-old  salesman  was  re- 
ferred with  a 21  hour  history  of  the  exist- 


for  July,  1970 


33 


Fig.  1 


ence  of  a cold,  painful,  pulseless  foot.  His 
past  history  was  positive  for  diabetes  melli- 
tus  and  prior  coronary  thrombosis.  Physical 
examination  was  negative  excejrt  for  the 
above  findings,  the  presence  of  a tender 
lump  in  the  right  popliteal  space,  and  the 
presence  of  a non-tender  pulsatile  mass  iu 
the  left  popliteal  space. 

Primary  resection  of  a thrombosed  popli- 
teal aneurysm  with  prosthetic  grafting  was 
done  3-4-59.  The  graft  was  successful,  with 
return  of  all  peripheral  pidses  and  no  resid- 
ual ischemic  compartment. 

Two  years  later  the  patient  expired  of 
recurrent  coronary  thrombosis;  autopsy 
confirmed  a patent  graft. 

Case  2.  A 71-year-old  insurance  adjuster 
was  referred  four  days  after  development 
unilaterally  of  a cold,  white,  painful  foot. 
Past  history  added  nothing,  and  the  physi- 
cal findings  were  only  as  described.  Femoral 
angiography  confirmed  a thrombosed  pop- 
liteal aneurysm,  with  minimal  collateral 
circulation.  Emergency  resection  of  the 
aneurysm,  with  primary  prosthetic  grafting, 
was  done  6-22-61.  Anterior  compartment 
changes  were  irreversible,  and  above-knee 
amputation  followed  on  6-25-61.  Figure  1 
illustrates  this  long,  fusiform  aneurysm. 

Five  years  later  he  was  referred  again, 
with  a similar  history  regarding  the  re- 
maining extremity,  in  spite  of  a warning 
that  he  should  seek  prompt  care  in  such 
an  instance.  Femoral  arteriogram  con- 
firmed a thrombosed  popliteal  aneurysm. 
This  time,  lumbar  sympathectomy  was 
done,  with  limb  survival.  No  rest  pain  re- 
sulted; the  patient  has  a useful  extremity 
two  years  later. 


Case  3.  On  9-3-63,  a 58-year-old  factory 
employee  presented  with  a 30  hour  history 
of  a cold,  white  foot.  Emergency  femoral 
angiography  confirmed  a thrombosed  pop- 
liteal aneurysm,  and  this  was  resected  and 
grafted  the  same  day.  Irreversible  changes 
tvere  present  and  below-knee  amputation 
eventuated.  Figure  2 shows  a series  of  berry- 
like lesions,  impossible  to  feel  in  the  popli- 
teal space. 

On  3-2-66,  three  years  later,  an  almost 
identical  sequence  occurred,  involving  the 
opposite  extremity.  The  single  variation 
was  that  the  amputation  was  above-knee. 
The  patient  remains  a bilateral  amputee, 
aged  62,  with  limiting  coronary  artery 
tlisease. 

Case  4.  A 54-year-old  outdoor  workman 
was  referred  because  of  a painful,  pulsating 
jjopliteal  mass.  Distal  pulses  were  strong. 
On  11-3-64,  the  popliteal  aneurysm  seen  in 
Figure  3 was  resected  and  grafted  with  a 
prothesis.  Recovery  was  uneventful;  peri- 
jiheral  pidses  remained. 

Follow-up  examination  six  months  later 
confirmed  an  aneurysm  in  the  other  leg. 
Resection  was  done  8-5-65,  and  total  occlu- 
sion of  the  popliteal  artery  distally  was 
found.  This  was  due  to  scarring  of  the  in- 
tiina,  seen  at  the  distal  end  of  the  aneurysm 
in  Figure  4.  The  collateral  circulation  was 
carefully  preserved,  the  aneurysm  resected, 
and  the  jnoximal  end  ligated.  Extremity 
loss  was  exjrected  but  did  not  occur,  cer- 
laiidy  due  to  adequate  collateral  circula- 
tion. Presently,  the  patient  has  unilateral 
claudication  only,  with  persistent  pulses 
aiul  no  claudication  on  the  grafted  side. 

Case  5.  A 45-year-old  musician  suddenly 
developed  a cold,  waxy  foot  on  4-29-66.  Four 
hours  after  onset,  angiography,  resection 
of  a thrombosed  popliteal  aneurysm,  and 
])iosthetic  grafting  was  done.  The  limb  sur- 
vived, l)ut  the  patient  was  left  with  a per- 
manent lootdrop,  preceded  by  the  charac- 
teristic evolution  of  an  ischemic  anterior 
compaitment.  No  pulses  returned.  Two 
years  later,  the  patient  has  a persistent  foot- 
drop,  but  continues  to  play  his  vibraharp 
well. 


Comment 

Our  small  series  of  cases  represents  five 
|>atients  with  eight  popliteal  aneurysms.  Of 
these,  two  were  apparently  patent  and  were 
operated  upon  electively;  six  were  operated 


34 


Illinois  Medical  Journal 


upon  at  the  time  of  acute  thrombosis,  on 
emergency  basis.  Of  these,  three  limbs  sur- 
vived, but  only  one  of  these  can  be  termed 
successfid  in  the  sense  of  a non-sympto- 
matic  limb  with  intact  foot  pulses.  It  ap- 
pears that  our  rate  of  success  also  is  at  50% 
limb  survival. 

Since  we  work  in  a community  hosjiital, 
dealing  only  sporadically  with  a wide  va- 
riety of  vascular  problems,  we  find  that  we 
have  had  no  continuing  policy  in  dealing 
with  popliteal  aneurysms.  We  have  dealt 
with  each  problem  individually.  There  are 
certain  factors  which  appear  to  have  al- 
tered the  clinical  outcome  of  this  disease. 
Some  of  these  are  matters  over  which  the 
physician  can  exert  no  influence;  some  are 
matters  in  which  the  surgeon’s  approach 
makes  the  difference  between  success  and 
failure. 

If  the  collateral  circulation  is  adequate, 
the  mode  of  treatment  of  thrombosed  pop- 
liteal aneurysm  makes  no  difference.  Acute 
occlusion  will  be  prognostically  determin- 
alile  if  the  usual  signs  of  ischemia  reverse 
tliemselves  in  a short  while.  Persistent  sen- 
sory and  motor  loss  almost  always  signify 
ultimate  amputation.  Recovery  of  motor 
activity  and  sensation  usually  signifies  an 
ultimately  useful  limb.  Limbs  three  and 
eight  illustrate  these  factors.  However,  the 
extent  of  collateral  circulation  is  a matter 
over  which  the  physician  exerts  no  in- 
fluence. 

I’he  physician  does  bear  directly  in  other 
areas.  Timing  is  of  j^aramount  importance. 
As  in  occlusive  disease  elsewhere,  the  longer 
a thrombus  is  extant,  the  further  the  prop- 
agation of  clot  into  adjoining  collateral 
vessels  and  in  the  distal  run-off.  The  more 


for  July,  1970 


I 


prompt  the  excision  of  the  thrombosed 
structure  and  re-establishment  of  arterial 
thrust,  the  more  certain  a surviving  limb. 
Since  most  patients  are  under  the  care  of 
those  not  oriented  to  these  problems,  stub 
born  and  persistent  education  and  re-edu- 
cation remain  fundamental  to  success.  The 
time  from  thrombosis  to  grafting  must  not 
be  more  than  3 to  4 hours,  if  any  success 
is  to  be  obtained.  Secondly,  arteriography 
will  definitely  aid  in  differentiating  acute 
arteriosclerosis  obliterans  from  thrombosed 
popliteal  aneurysm.  The  latter  simply  has 
to  be  approached  from  a stiaight  posterioi 
position;  unawareness  of  the  differential  re- 
sidts  in  a need  for  changing  patient  posi- 
tion or  fighting  a very  poor  exposure  to  the 
end  of  the  operation.  Limb  loss  always  has 
medico-legal  implications.  Although  the 
subtleties  of  occlusive  disease  may  easily  be 
interpreted  by  physical  examination  by  the 
vascular  surgeon,  they  are  not  so  clear  to 
other  consultants,  attorneys,  and  jurymen. 
An  arteriogram  permits  easy  explanation 


Fig.  4 


S5 


and  leaves  a j^ermanent  record  for  future 
reference. 

Aggressiveness  is  certainly  indicated  in 
thrombosed  jropliteal  aneurysm.  What  to 
do  with  jratent  popliteal  aneurysms  remains 
in  doubt.  Our  limited  experience  with  these 
was  gratifying;  I wish  we  had  been  so  for- 
tunate with  thrombosed  aneurysms.  If  the 
patient  can  understand  the  problems  in- 
volved and  accept  the  risk  of  limb  loss,  ad- 
vising elective  resection  seems  reasonable. 
In  almost  30  years,  no  one  has  duplicated 
the  results  of  Lintou,  which  were  indeed 
excellent.  The  inescapable  conclusion  seems 
to  be  that  lumbar  sympathectomy  contrib- 
utes considerably  to  limb  survival  when 
there  develops  a complication  of  popliteal 
aneurysm. 

Concliision 

The  treatment  of  thrombosed  pojrliteal 
aneurysnr  is  unsatisfactory.  Earlier  diag- 
nosis, arteriography,  resection  aird  grafting 
seem  the  best  solution.  Lumbar  sympathec- 


tomy undoubtedly  contributes  considerably 
to  recovery.  Courage  on  the  part  of  the 
surgeon  and  patient  alike  are  necessary  to 
permit  excision  and  grafting  of  non-sympto- 
matic  patent  aneurysm.  M 

References 

1.  Linton,  R.  R.:  “The  arteriosclerotic  popliteal 
aneurysm.”  Surgery,  26:41,  1949. 

2.  Baird.  R.  J.,  Sivasankar,  R.,  Hayward,  R.,  Wil- 
son, D.  R.:  “Popliteal  aneurysms:  a review  and 
analysis  of  61  cases.”  Surgery,  59:911,  1966. 

3.  Giftord,  R.  4V.,  Hines,  E.  A.,  Jr.,  and  Janes, 
J.  M.:  “An  .Analysis  and  follow-up  study  of  one 
hundred  jtopliteal  aneurysms.”  Surgery,  33:284, 
1953. 

4.  Friesen,  G.,  Ivins,  J.  C.,  and  Janes,  J.  M.: 
"Popliteal  aneurysms.”  Surgery,  51:90,  1962. 

5.  Crawford,  E.  S..  DeBakey,  M.  E.,  and  Cooley, 
D.  A.:  "Surgical  considerations  of  peripheral 
arterial  aneurysms.”  A.M.A.  Archives  of  Sur- 
gery, 78:226,  1959. 

6.  Hunter,  J.  A.,  Jtilian,  O.  C.,  Javid.  H.,  Dye, 
\V.  S.:  “Arteriosclerotic  aneurysms  of  the  pop- 
liteal artery.”  J.  Cardiov.  Surg.,  1:404,  1961. 

7.  Hara,  M.,  Thompson,  B.  W.:  “The  hazards  of 
popliteal  aneurysms.”  A.M.A.  Archives  of  Sur- 
gery, 92:504,  1966. 

Order  reprints  from  8ti0  Summit,  Elgin,  60120. 


Modern  Diets  Proving 

Modem  diets  are  proving  harmful  to  the 
teeth  of  Eskimos  living  in  northern  Can- 
ada, a dental  anthropologist  at  The  Llni- 
versity  of  Chicago  has  reported. 

A paper  presented  by  Dr.  John  T.  May- 
hall,  a post-doctoral  trainee  at  The  Uni- 
versity of  Chicago,  describes  preliminary 
studies  which  indicate  that  modern  food 
now  being  consumed  by  Eskimos  in  the 
Northwest  Territories  of  Canada  is  de- 
teriorating their  teeth. 

“A  study  of  the  teeth  of  the  Eskimos  of 
Igloolik  and  Hall  Beach,  Northwest  Terri- 
tories, Canada,”  Dr.  Mayhall  said,  “reveals 
that  with  the  introduction  of  modern  foods 
and  tastes,  the  dental  health  of  the  Eskimo 
inhabilants  of  these  isolated  Foxe  Basin  vil- 
lages is  deteriorating.” 

“The  principal  change  affecting  the  den- 
tition during  this  modernization  is  a new 
diet  which  is  extremely  different  from  that 
which  was  prevalent  only  a short  time  ago 
and  to  which  some  of  the  Eskimos  living 
in  the  more  isolated  circumstances  still 
adhere.” 

Dr.  Mayhall  said  the  tooth  decay  rate 
for  permanent  teeth  in  Igloolik  nearly 
doid:)led  in  those  people  who  had  a diet 
consisting  of  more  than  60%  food  obtained 
at  the  local  stores  as  compared  with  those 


Harmful  To  Teeth 

individuals  wlio.se  diet  is  principally  food 
olitained  from  hunting  and  fishing. 

“ I'he  latter’s  main  staples,”  Dr.  Mayhall 
said,  “appear  to  be  seal,  cariboti,  fish,  and 
some  walrus.  Ccnerally,  those  who  had  the 
‘native’  diet  had  less  calculus  (tartar)  on 
their  teeth  than  did  those  on  the  modern 
diet.” 

The  study  was  supported  by  the  National 
Research  Council  of  Canada  through  the 
Canadian  International  Biological  Pro- 
gramme, Human  Adaptability  section.  It 
was  undertaken  in  1968  to  ascertain  the 
effects  of  a rapidly  changing  culture  upon 
the  dentition  of  the  Eskimos  of  the  North- 
west Territories. 

“It  (the  study)  was  a part  of  a multi- 
disciplinary study  of  Eskimos,”  Dr.  May- 
hall said,  “and  the  results  presented  here 
are  preliminary  and  based  only  upon  the 
author’s  (Dr.  Alayhall’s)  observations  with- 
out the  aid  of  results  from  the  other  in- 
vestigators. With  this  material  available  in 
the  future,  more  enlightening  data  will  be 
available.” 

“At  present,  a comprehensive  dietary  sur- 
vey is  under  way  by  Miss  Heather  Milne 
of  the  Elniversity  of  Toronto,  which  will 
be  available  for  a more  detailed  sttidy  of 
the  effects  of  diet.” 


36 


Illinois  Medical  Journal 


4‘i  |i^’'^#“ 

;;iv 

V^'ty 

"*  <r-i- 

■ ’ :?:  f-*7-"'':4t5rtf 
'.  /■'I' 


»*=:■  •i''-^&'>-i*VY^'f 


Surs;ical  Grand  Rounds  are  held  weekly  on  Saturday  at  8:00  a.m.,  alter- 
nating; between  the  Staff  Room,  Chicago  Wesley  Memorial  Hospital,  and 
Ofpetd  Auditorium,  Passavant  Mejnorial  Hospital.  Patient  presentations 
from  these  hospitals  and  from  the  Veterans  Administration  Research  Hos- 
pital form  the  basis  of  the  discussions.  This  case  report  was  part  of  the 
Surgical  Grand  Rounds  held  at  Passavant  Memorial  Hospital  on  March 
22,  "l969. 


Ureteral 

Obstrrictioii 


Edited  by  John  M.  Beal,  M.D. 

CASE  REPORT: 

Dr.  Gerald  Halperii:  A 76-year-old  male 
was  admitted  to  Passavant  Memorial  Hos- 
pital lor  the  first  time  on  Feb.  26,  1969, 
(or  the  evaluation  of  recurring  hematuria, 
riie  patient  was  well  until  1960,  when, 
after  an  episode  of  hematuria,  he  was  dis- 
covered to  have  a bladder  tumor.  Trans- 
urethral removal  of  the  tumor  was  per- 
formed. l ire  patient  was  well  for  five  years. 
However,  in  1965  he  had  an  episode  of 
gross  hematuria  and  again  transurethral 
resection  of  the  bladder  tumor  was  re- 
quired. From  1965  to  1968,  the  patient  was 
subjected  to  cystoscopy  yearly.  On  each  oc- 
casion, a bladder  tumor  was  found  and  re- 
sected endoscopically.  In  Jidy,  1968,  an  in- 
travenous urogram  showed  non-function  of 
the  right  kidney.  One  month  prior  to  ad- 
mission, he  again  developed  total  gross 
liematuria  with  dysuria  and  frequency  and 
hourly  nocturia  associated  with  a dribbling 
stream  and  hesitancy. 

Physical  examination  at  the  time  of  ad- 
mission: The  patient  was  a pale,  elderly 
white  male.  Blood  pressure  160/70,  pulse 


Fig,  1.  Intravenous  pyelogram,  four  hours  af- 
ter injection,  demonstrated  hydroncphrotic  left 
renal  pelvis. 


38 


Iltinois  Medical  Journal 


Fig.  2.  Triple  exposure  film  of  the  bladder 
showed  good  mobility  of  the  left  bladder  wall 
during  emptying.  The  large  arrow  indicates 
area  of  fixation  of  right  bladder  wall. 

72,  temperature  normal.  Examination  rvas 
within  normal  limits,  except  for  the  pros- 
tate which  was  moderately  enlarged  but 
smooth  and  symmetrical.  Enlargement  of 
the  spleen,  kidneys,  or  liver  was  not  de- 
tected. Laboratory  data  shorved  a hemo- 
globin of  7.1  Gm.,  hematocrit  22%.  His 
white  count  was  6,400,  and  his  sedimenta- 
tion rate  was  69.  BUN— 62,  uric  acid— 5.1, 
creatinine— 4.7  mg./%.  Urine  was  sterile 
when  cultured. 

Dr.  Michael  Murphy:  A double  dose  in- 
travenous pyelogram  was  done  in  Eebruary 
and  it  again  showed  non-visualization  ol 
the  right  side.  At  15-minutes  there  was  faint 
visualization  on  the  left.  A follow-up  him 
taken  four  hours  after  injection  showed 
dehnite  excretion  of  contrast  material  into 
a hydronephrotic  left  renal  pelvis  (Eig.  1). 
Renogram  conhrmed  the  hndings  of  the 
LV.P.  It  showed  poor  function  bilateralfy; 
there  was  uptake  of  radioactivity  on  the 
left,  but  none  on  the  right.  Cystogram 
failed  to  show  intrinsic  defects  in  the  blad- 
der. After  this  study  was  completed,  the 
bladder  was  distended  with  contrast  ma- 
terial, and  a triple  exposure  him  was  taken 
as  the  bladder  emptied  (Eig.  2).  I believe 
you  can  see  the  three  outlines  of  the  blad- 
der wall  on  the  left,  corresponding  to  the 


three  exposures.  However,  the  bladder  wall 
on  the  right  side  is  relatively  hxed.  Al- 
though hbrous  adhesions  from  previous  sur- 
gery and  radiation  could  cause  this,  we 
thought  that  it  was  more  probably  caused 
by  recurrent  bladder  tumor. 

Dr.  Halpern:  At  this  time,  the  clinical  im- 
pression was  recurrent  bladder  tumor  with 
bilateral  ureteral  obstruction  causing  urem- 
ia. After  transfusions  of  whole  blood,  cys- 
toscopy was  |rerformed  on  March  4.  A 
bladder  tumor  could  not  be  visualized  en- 
doscopically:  however,  two  suspicious  areas 
at  the  bladder  neck  were  biopsied,  which 
did  not  demonstrate  malignancy.  He  did 
have  a stricture  at  the  ureterovesical  junc- 
tion and  also  a mild  bladder  neck  contrac- 
tion. It  was  decided  that  the  patient  woidd 
benefit  from  diversion  of  his  urinary  stream, 
and  therefore,  two  days  following  cysto- 
scopy, a left  cutaneous  ureterostomy  was 
performed.  The  patient  has  had  a satisfac- 
tory course  since  operation. 

Dr.  Joseph  Sherrick:  In  spite  of  the  fact 
that  this  patient  had  been  treated  for  carci- 
noma ol  the  bladder  since  1960,  we  were 
unable  to  find  any  tumor  in  the  multiple 
biopsies  of  the  bladder  taken  by  Dr.  Hal- 
pern. In  one  biopsy  (Eig.  3),  there  was  a 


Fig.  3.  Biopsy  of  bladder  wall  was  interpreted 
as  demonstrating  edema  and  inflammation. 


for  July,  J970 


39 


Fig.  4.  The  bladder  mucosa  was  distorted  and 
showed  atypical  hyperplasia,  probably  related 
to  previous  irradiation. 


Structure  composed  of  distended  lympha- 
tics and  edematous  connective  tissue  which 
is  an  inflammatory  polyp.  The  epithelium 
covering  all  the  biopsies  seemed  thicker 
than  in  the  normal  urinary  bladder.  On 
close  examination,  one  can  see  that  there 
is  some  loss  of  stratification  of  the  epithe- 
lium, but  the  transitional  pattern  is  still 
preserved.  Some  of  the  epithelial  cells  are 
pleomorphic,  but  there  is  no  mitotic  ac- 
tivity (Fig.  4).  We  regard  this  as  being 
atypical  hyperplasia  of  the  bladder  epithe- 
lium and  not  cancer.  This  pecidiar  dysplas- 
tic  change  may  jrossibly  be  related  to  radia- 
tion or  to  unknown  factors.  It  would  be  of 
great  interest  to  have  an  opportunity  to 
review  the  bladder  biopsies  taken  from  this 
patient  at  other  hospitals  since  I960. 

Dr.  John  Grayhack:  This  patient  actually 
demonstrates  the  value  of  establishing  a 
definite  diagnosis.  He  presented  with  a his- 
tory which  was  typical  for  carcinoma  of  the 
bladder.  He  had  had  history  of  transitional 
cell  carcinoma  of  the  bladder  with  repeated 
recurrences  documented  over  a nine  year 
period.  Hematuria  and  bladder  symptoms 
were  persistent.  The  patient  then  developed 
ureteral  obstruction  and  was  actually  se- 


verely azotemic  and  anemic  when  he  was 
first  seen  by  us.  Our  initial  impression  of 
this  76-year-old  man  was  that  he  had  both 
ureters  obstructed  by  his  carcinoma,  one 
totally  probably  and  the  other  partially  for 
only  eight  months,  and  that  there  was 
little  reason  to  be  too  vigorous  in  pursuit 
of  either  a diagnostic  or  a therapeutic  regi- 
men. On  reflection,  we  recognized  that  our 
presumptive  diagnosis  should  be  verified. 
Surprisingly,  we  could  not  document  the 
presence  of  persistent  malignancy  despite 
multiple  biopsies.  We  were  unable  to  iden- 
tify either  ureteral  orifice  at  cystoscopic 
examination.  These  findings  suggested  that 
the  patient  had  a fibrotic  obstruction  of 
both  ureters  following  transurethral  resec- 
tion, a phenomenon  which  is  recognized 
but  rare.  Finder  these  circumstances,  we 
elected  to  divert  the  patient’s  urinary 
stream.  Several  types  of  permanent  diver- 
sion are  available  in  a patient  who  requires 
supravesical  diversion  (Fig.  5).  Actually, 
nephrostomy  tube  drainage  is  a satisfactory 
form  of  diversion.  It  is  usually  used  for 
temporary  rather  than  long-term  diver- 
sion. The  various  types  of  cutaneous  ure- 
terostomy are  also  shown.  Probably  the 
most  satisfactory  is  the  high  cutaneous  ure- 
terostomy. This  procedure  utilizes  the  well 
vascidarized  upper  third  of  the  ureter. 
Ureteral  length  is  adequate  to  permit  ure- 
teral cutaneous  anastomosis  without  ten- 
sion. Fitting  an  adequate  appliance  to  the 
ureterostomy  site  is  difficult.  The  classical 
cutaneous  ureterostomy,  utilizing  the  mid- 
dle third  of  the  ureter,  produces  a no- 
toriously bad  result  unless  the  ureter  is  di- 
lated. This  is  probably  due  to  two  factors: 
1)  the  blood  supply  to  this  segment  of  ure- 
ter is  poor.  The  lower  third  of  the  ureter 
receives  the  major  portion  of  its  blood  sup- 
ply from  below.  In  this  procedure,  you  di- 
vide the  ureter  at  about  the  site  of  its  poor- 
est blood  supply.  2)  When  you  bring  the 
ureter  retroperitoneally,  you  rarely  have 
enough  length  to  reach  the  skin  without 
tension.  These  factors  result  in  a high  inci- 
dence of  stricture  of  the  stoma  and  slough 
of  the  distal  ureter,  complications  that  have 
caused  this  particular  type  of  diversion  to 
fall  into  disrepute.  The  single  stoma  trans- 
peritoneal  ureterostomy  has  been  utilized 
primarily  in  youngsters  but  is  gaining  popu- 
larity in  other  instances  since  we  have 
learned  from  the  use  of  the  ileoconduit  that 


40 


Illinois  Medical  Journal 


we  can  cross  the  peritoneal  cavity  with  a 
tubular  structure  and  still  not  get  into  too 
much  trouble  with  intestinal  obstruction. 
The  classical  and  high  ileal  conduits  are 
probably  the  most  satisfactory  types  of  su- 
pravesical diversion  from  the  standpoint  of 
long  term  survival.  A mortality  rate  of 
about  3%  is  associated  with  the  ileal  con- 
duit for  nonmalignant  disease.  Ureterosig- 
moidostomy,  shown  at  the  bottom  of  Fi- 
gure 5,  cannot  be  utilized  with  safety  in 
a patient  who  has  a large,  dilated  ureter. 
It  does  have  a place  as  a palliative  proced- 
ure and  actually  has  a place  in  some  elder- 
ly patients  in  whom  attempted  curative  sur- 
gery is  carried  out.  It  has  a disadvantage 
in  that  there  is  a high  incidence  of  pyelo- 
nephritis following  it  as  well  as  the  pecu- 
liar hyperchloremic  acidosis  which  is  asso- 
ciated with  a large  percentage  of  patients 
who  have  this  type  of  diversion.  In  this 
man,  we  elected  to  do  a cutaneous  ureter- 
ostomy on  the  left  side  only  since  he  was 
a poor  risk  patient.  We  knew  that  the 
right  side  was  not  functioning,  at  least  by 
intravenous  pyelography,  for  some  ten 
months.  The  ureter  which  was  obstructed 
at  the  ureterovesical  junction  was  very 
thick-walled,  a finding  which  suggests  an 
increased  blood  supply  to  the  ureter.  This 
is  the  type  of  ureter  which  is  ideal  for  a 
cutaneous  ureterostomy.  We  brought  the 
ureter  in  a transperitoneal  course  so  that 
it  could  approach  the  skin  directly  and  be 
under  less  tension.  In  the  postoperative 
period,  the  patient  had  an  interesting 
phenomenon  which  is  often  seen  in  pa- 
tients with  marked  renal  failure.  His  blood 
urea  nitrogen  went  from  60  to  about  130 
mg.%.  His  creatinine  rose  but  not  to  the 
same  extent  as  his  BUN.  The  question  of 
dialysing  him  was  raised  just  about  the  time 
he  began  a diuresis.  His  BUN  now  is  about 
30.  The  phenomenon  of  apparent  increas- 
ing renal  failure  in  the  postoperative  period 
could  well  be  related  to  an  increasing  ob- 
struction from  the  non-intubated  cutaneous 
ureterostomy  and  the  extra  load  placed 
on  the  kidney  by  the  tissue  breakdown 
associated  with  the  surgical  procedure. 
One  thing  that  you  must  remember  in 
a patient  who  has  renal  failure  of  this 
nature,  who  requires  an  operative  pro- 
cedure, is  that  you  have  to  be  careful 
about  fluid  replacement  and  particularly 
about  potassium  administration  or  accumu- 
lation. Since  hemolysis  may  increase  the 


Methods  of  Permanent  Urinary  Diversion 


Cutaneous  Ureterostomy 


High  Classical  Midline  Single  Stoma 

Ileal  Conduit 


Fig.  5.  (labeled  Methods  of  Permanent  Urinary  Diversion). 


serum  potassium  of  blood  signihcantly, 
prior  to  administering  large  quantities  of 
blood  to  these  patients  you  ought  to  make 
an  effort  to  get  fresh  blood  and  to  arrange 
to  monitor  serum  potassium  and  ECG 
changes  closely. 

Dr.  John  Beal:  Was  re-implantation  of 
the  ureter  into  the  bladder  considered? 

Dr.  Grayhack : This  was  a consideration. 
Despite  the  negative  biopsies,  we  weren’t 
entirely  sure  that  the  patient  didn’t  have 
bladder  cancer.  We  biopsied  the  lower  end 
of  the  ureter  and  perivesical  area;  these 
biopsies  showed  fibrosis,  but  no  evidence  of 
carcinoma.  This  ureter  had  a diameter  of 
about  1.5  cm.,  and  probably  two-thirds  of 
that  was  the  wall.  To  attempt  to  reimplant 
that  in  a man  who  already  has  renal  failure 
and  in  whom  any  minor  insult  might  be 
a terminal  one  would  be  very  hazardous. 
If  you  knew  the  status  of  the  bladder  with 
certainty  and  if  you  had  a ureter  which  you 
could  implant,  neither  of  which  was  true. 


for  July,  1970 


41 


reimplantation  would  deserve  primary  con- 
sideration. His  right  kidney  is  fnnctionless 
as  far  as  we  can  tell.  He  passes  no  urine 
from  his  bladder.  He  undoubtedly  has  a 
hydronephrotic  sac  on  the  right  side  which 
we  do  not  intend  to  molest. 

Dr.  Douglas  Dahl:  Were  you  certain  that 
the  right  kidney  was  not  making  urine? 
Dr.  Grayhack:  No,  I was  not.  We  were 
faced  with  the  possibility  of  doing  a bi- 
lateral cutaneous  ureterostomy  for  a non- 
functioning kidney  which  would  leave  us 
with  an  open  infected  draining  stump  and 
which  would  require  prolongation  of  an 
operative  procedure  in  a seriously  ill  old 
man.  We  considered  doing  a transuretero- 
ureterostomy, joining  the  right  ureter  to 
the  left  and  bringing  the  left  to  the  skin. 
We  didn’t  feel  that  it  was  worth  while 
jeopardizing  the  one  good  ureter  for  one 
that  we  thought  was  no  good.  We  felt  that 
if  urine  production  by  the  right  kidney 
caused  him  symptoms  without  contributing 
significant  function,  and  his  left  side  re- 


covered function,  the  ideal  procedure 
would  be  to  do  a right  nephrectomy  in  this 
man  later.  We  were  concerned  about  the 
status  of  the  right  kidney,  but  our  assump- 
tions seem  well  founded. 

Dr.  Stuart  Poticha:  When  you  bring  the 
ureter  out  to  the  skin  of  the  abdomen,  do 
you  attempt  to  fix  it  to  the  lateral  peri- 
toneal wall? 

Dr.  Grayhack:  The  transperitoneal  ure- 
terostomy is  not  done  commonly.  We  bring 
the  left  ureter  medial  to  the  colon,  usually 
at  the  level  of  the  sigmoid.  A flap  of  pos- 
terior peritoneum  with  the  mesosigmoid  is 
utilized  to  cover  the  ureter  in  part.  A major 
segment  of  the  ureter  is  still  retroperito- 
neal. We’ve  not  anchored  the  sigmoid  to 
the  ureter,  although  we’ve  wondered  about 
it.  The  ureteral  blood  supply  is  so  tenuous, 
that  we  really  hesitate  to  place  sutures  in 
the  mid-ureter.  We  put  one  suture  in  the 
periureteral  tissue  as  the  ureter  enters  the 
parietal  peritoneum  and  the  posterior  fas- 
cia; except  for  this,  we  rely  upon  skin  su- 
tures to  secure  it. 


New  Pharmaceutical  Specialties 

{Continved  from  page  26) 

Indications:  Variety  of  infections  susceptible  to 
sulfonamide  therapy. 

Contraindications:  Hypersensitivity  to  sulfona- 
mides. Infants  less  than  2 months  of  age.  Preg- 
nancy at  term  and  during  nursing. 

Dosaee:  Varies  with  age  and  indication. 

Supplied:  Tablets,  0.5  gm. 

STEPS  Vasodilator  P 

Manufacturer:  Dow 

Nonproprietary  Name:  Pentaerythritol  tetrani- 
t^ate 

Indications:  Relief  and  prophylactic  treatment  of 
angina  pectoris. 

Contraindications:  Idiosyncrasy  to  drug. 

Dosage:  1 capsule  every  12  hrs.  on  an  empty 
stomach. 

Supplied:  Timed  disintegration  capsules,  30,  50 
and  80  mg. 

tetanus  immune 

Gt.obuLIN  (Human)  Biological  R 

Manufacturer:  Wyeth 

Nonproprietarv  Name:  Human  gamma  globulin 
16.5  (±1.5)  % sol. 

Indications:  Immunization  against  tetanus 
Contraindications:  Do  not  give  intravenously. 
Dosage:  Adults:  i.m.,  250  units. 

Children:  i.m.,  4.0  units/kg. 

Supp’ied:  Solution  (Tubex) 

TUBERCULIN  Diagnostic  R 

Manufacturer:  Connaught  Medical  Research  La- 
boratories, Canada 
Distributor:  Panray  Div.,  Ormont 
Nonproprietary  Name:  Stabilized  tuberculin, 

purifipd  protein  derivative  (Mantoux) 
Indications:  Intracutaneous  tuberculin  testing 
Contraindications:  None  mentioned. 


Dosage:  Initial  intracutaneous  tuberculin  test, 
5 T.U. 

Supplied:  Vials,  1-5  cc 

COMBINATION  PRODUCTS 


FERROBID  Hematinic  R 

Manufacturer:  Meyer 

Composition:  Ferrous  fumarate  225  mg. 

Copper  sulfate  8 mg. 

Ascorbic  acid  100  mg. 


Indications:  Prevention  and  treatment  of  iron 
deficiency  anemias. 

Contraindications:  None  mentioned. 

Dosage:  Adults:  One  capsule  twice  daily.  More 
severe  anemias:  One  capsule  t.i.d. 

Children:  As  directed. 

Supplied:  Duracap  timed  action  capsules. 

DEMULEN  Oral  Contraceptive  R 

Manufacturer:  Searle 

Composition:  Ethynodiol  diacetate  1 mg. 

Ethinyl  estradiol  50  meg. 

Indications:  Oral  contraception. 

Contraindications:  Thrombophlebitis,  thrombo- 

embolic disorders,  cerebral  apoplexy  or  a past 
history  of  these  conditions.  Markedly  impaired 
liver  function.  Known  or  suspected  carcinoma 
of  the  breast  or  estrogen-dependent  neoplasia. 
Undiagnosed  abnormal  genital  bleeding. 

Dosao'e:  One  tablet  daily  in  20  day  cycles. 

Supplied:  Tablets. 

MTC  Oil  Nutrient  o-t-c 

Manufacturer:  Mead  Johnson 

Composition:  Lipid  fraction  of  coconut  oil  con- 
sisting primarilv  of  triglycerides  of  the  C^,  and 
C,r,  saturated  fatty  acids. 

Indications:  Restriction  of  dietary  fat  intake  to 
medium  chain  triglycerides. 

Contraindications:  None  mentioned. 

Dosage:  3-4  tbs.  daily  mixed  with  food. 

Supplied:  Oil 


42 


Illinois  Medical  Journal 


1 


Do  It!  By  Jerry  Rubin,  Simon  and  Schus- 
ter, New  York,  N.Y.  $2.45 

In  the  wake  of  the  violence  that  swept 
across  the  campuses  and  the  country  in  the 
past  few  weeks,  we  have  become  intrigued 
with  a depraved  little  volume  published  by 
Simon  and  Schuster  called  Do  It!  Written 
by  Jerry  Rubin,  one  of  the  “Chicago  7” 
gang  recently  convicted  of  crossing  state 
lines  to  provoke  a riot,  the  book— aside 
from  being  saturated  with  obscene  language 
—spells  out  some  of  the  thinking  of  Ameri- 
ca’s youthful  revolutionaries. 

Rubin,  indeed,  is  quite  frank.  He  says 
the  idols  of  the  New  Left  are  Che  Guevara, 
Fidel  Castro,  and  the  Viet  Cong— and  he 
appears  to  relish  the  idea  of  bringing  guer- 
rilla warfare  to  the  United  States. 

He  approves  of  virtually  any  tactic  to 
bring  clown  the  Establishment,  including 
sabotage,  treason  and  the  killing  of  cops. 
“We’ve  combined  youth,  music,  sex,  drugs 
and  rebellion  with  treason— and  that’s  a 
combination  hard  to  beat,’’  he  says  at  one 
point. 

At  still  another:  “When  in  doubt,  burn. 
Fire  is  the  revolutionary’s  god.  Burn  the 
flag.  Burn  churches.  Burn,  burn,  bnrn.” 
Jerry  is  also  for  stealing:  “All  money  is 
theft,’’  he  says.  “To  steal  from  the  rich,” 


he  continues,  “is  a sacred  and  religious  act. 
To  take  what  you  need  is  an  act  of  self- 
love,  self  liberation.  While  looting,  a man 
to  his  own  self  is  true.” 

The  well-known  Yippie  leader  acknowl- 
edges that  the  demands  of  demonstrators 
are  deliberately  unreasonable.  The  basic 
bargaining  tactic  of  the  revolutionary,  he 
says,  is:  “Give  us  an  inch— and  we’ll  take 
a mile.  Satisfy  our  demands  and  we  got  12 
more.  The  more  demands  you  satisfy,  the 
more  we  got.  . . . Demonstrators  are  never 
reasonable.  We  always  put  our  demands 
forward  in  such  an  obnoxious  manner  that 
the  power  structure  can  never  satisfy  us 
and  remain  the  power  structure.  Then,  we 
scream,  righteously  angry,  when  our  de- 
mands are  not  met.” 

Jerry  Rubin  has  written  The  Communist 
Manifesto  of  our  era.  Do  It!  is  a Declara- 
tion of  War  between  the  generations— call- 
ing on  kids  to  leave  their  homes,  burn 
down  their  schools  and  create  a new  so- 
ciety upon  the  ashes  of  the  old.  . . . 

For  those  of  you  who  appreciate  the  form 
of  government  we  now  have,  you  might 
want  to  read  about  those  who  would  change 
our  system.  You  may  not  enjoy  reading 
Do  It!  but  it  should  be  an  eye  opener. 


The  Pill 

Science  writers  also  appear  to  be  moving  toward  more  sophisticated 
levels  of  analytical  reporting  of  science's  economics,  politics  and  priorities. 
In  his  book,  THE  PILL,  Morton  Mintz  of  the  Washington  Post  chronicles  just 
how  the  degree  of  danger  seen  in  birth  control  pills  depends  a great  deal 
on  the  expert's  viewpoints.  Medical  scientists  fixed  upon  the  problems  of 
population  explosion  rate  the  risks  as  very  small,  less  dangerous  than  preg- 
nancy. Researchers  and  doctors  focused  on  individual  patients,  generally  in 
the  upper  and  middle  classes,  considered  the  risks  of  pregnancy  less  serious 
than  risking  complications  associated  with  hormone  contraception.  Judith 
Randal,  writing  in  the  Washington  Star,  criticizes  the  medical  men  for  for- 
getting—or  ignoring— the  desirability  of  warning  patients  that  all  powerful 
drugs  involve  risks.  (Warren  Burkett,  "There's  More  Going  On  in  Science 
Than  Some  Would  Tell,"  The  Quill  [May]  1970,  pages  16-19.) 


r 


for  July,  1970 


43 


Failure  of  thymectomy 

In  a six-year  old  child 

With  myasthenia  gravis 


By  Chang  Hwan  Kim,  M.D.,  Bennett  R.  Sherman,  M.D., 
AND  Meyer  A.  Perlstein,  M.D. /Chicago 


Thymectomy  for  myasthenia  giavis  was 
first  reported  in  1939,  by  Blalockd  Most  re- 
ports deal  with  thymectomy  in  adults;  only 
a few  in  children. 

d’hymectomy  has  been  jrerformed  mainly 
when  a thymoma  is  present  and  particular- 
ly in  female  patients  between  20  and  35 
years  of  age.  Since,  with  advanced  surgical 
technics,  thymectomy  can  be  carried  out 
with  minimum  risk,  the  procedure  may  be 
indicated  when  there  is  poor  response  to 
medical  regimen. 

The  case  being  reported  here  documents 
another  instance  of  myasthenia  giavis  in  a 
6-year  old  child  and  the  failure  of  thymec- 
tomy to  have  therapeutic  benefit. 

Case  Report 

H.  C.,  an  18-month-old  Negro  male  (6 
years  old  at  the  time  of  surgery)  was  admit- 
ted to  the  Children’s  Division  of  Cook 
County  Hospital  on  Nov.  11,  1962,  for 
evaluation  of  complaint  that  for  two  weeks 
he  was  unable  to  open  his  right  eye.  The 
patient  appeared  normal  in  the  morning, 
but  later  in  the  day  his  right  lid  began 
to  droop,  and  by  evening  was  almost  com- 
pletely closed.  He  was  first  born  to  a 20- 
year  old  mother  after  an  uncomplicated 
pregnancy.  Birthweight  was  eight  pounds. 
There  was  no  history  of  familial  or  heredi- 
tary illnesses. 

On  physical  examination,  ptosis  of  the 
right  lid  was  the  only  abnormal  finding. 
At  a previous  admission  for  respiratory  in- 
fection two  months  earlier,  no  eye  abnor- 
mality had  been  noted.  There  was  no  dys- 


phagia. Five  milligrams  of  Tensilon  was 
injected  intravenously  following  which  the 
child  was  able  to  move  his  lid  in  normal 
fashion.  A diagnosis  of  myasthenia  giavis 
was  made. 

Treatment  was  begun  with  prostigmin, 
7.5  mg.  giadually  increased  to  22.5  mg. 
t.i.d.,  and  ephedrine,  8 mg.  each  morning. 


Chang  Mwan 
Kim,  M.D.  (far 
left),  is  a pedi- 
atric neurolo- 
gy consultant, 
Reed-  Chicago 
State  Hospital. 
He  is  a graduate 
of  the  Yeun  Sei 
Univ.  College  of 
Medicine,  Seoul,  Korea  and 
served  his  internship  in  Al- 
bany, N.Y.,  and  a residency 
at  Jefferson  Medical  College 
Hospital,  Philadelphia.  In  ad- 
dition he  has  done  fellowship 
work  in  pediatric  neurology 
under  the  United  Cere- 
bral Palsy  Foundation  at 
Cook  County  Hospital.  Ben- 
net  R.  Sherman,  M.D.,  (left) 
is  a practicing  pediatrician  and  an  associate 
in  pediatrics  at  Cook  County,  Evanston  Hospi- 
tal and  Northwestern  Univ.  Medical  School.  He 
received  his  M.D.  from  the  Univ.  of  Illinois 
College  of  Medicine  and  served  his  internship 
and  residency  at  Michael  Reese.  M.  A.  Perlstein, 
M.D.  (below  left)  was  professor  of  pediatrics, 
Northwestern  Medical  School  and  head  of  Pe- 
diatric Neurology  at  Cook  County  Hospital.  A 
graduate  of  Rush  Medical  School,  Dr.  Perlstein 
served  his  internship  and  residency  at  Cook 
County.  Dr.  Perlstein  died  recently  after  mov- 
ing to  California. 


44 


Illinois  Medical  Jourrml 


The  ptosis  however,  did  not  improve.  In 
fact,  the  patient  developed  ptosis  of  the 
left  lid  also.  Prostigmin  was  discontinued 
and  the  patient  was  started  on  Mestinon, 
120  mg.  daily,  gradually  increasing  to  60 
mg.  q.i.d.,  before  a favorable  response  was 
obtained.  The  child  was  discharged  on  Dec. 
22,  1962,  six  weeks  after  admission. 

Continuing  Treatment 

Following  this  hrst  admission  there  have 
been  13  additional  admissions  to  the  hos- 
pital in  five  years.  Many  of  these  were  for 
respiratory  distress,  with  asthma  generally 
associated  with  a bronchiolitis  which  re- 
sponded to  epinephrine,  aminojahylline  and 
intravenous  fluids. 

On  admission  on  January  20,  1966,  he 
was  also  given  corticosteroids.  At  this  time, 
a cholinergic  reaction  was  considered  and 
Mestinon  was  withdrawn.  Ptosis  and  asth- 
matic symptoms  persisted.  The  patient  be- 
came refractory  to  Mestinon  and  the  ptosis 
persisted  in  spite  of  giving  sufficient  drug 
to  cause  abdominal  cramps.  The  patient 
was  then  tried  on  Mytelase,  5 mg.  t.i.d. 
increasing  to  10  mg.,  t.i.d.  This  also  was 
discontinued  after  a week  when  the  patient 
failed  to  respond. 

An  electromyogram  was  normal.  I’he  pa- 
tient was  discharged  without  medication 
and  was  doing  well  other  than  for  ptosis 
until  he  was  re  admitted  on  Dec.  1,  1967, 
at  the  age  of  6 years,  in  acute  respiratory 
distress  with  asthmatic  symptoms.  His  acute 
symptoms  were  alleviated  with  epinephrine, 
aminophylline,  Tedral  and  supportive  mea- 
sures. Examination  at  this  time  showed 
total  paralysis  of  all  extra-ocular  muscles. 

Laboratory  work  including  hemogram, 
urinalysis  and  blood  chemistry  was  normal. 
Chest  X-ray  showed  no  thymic  enlarge- 
ment. Because  of  his  extreme  refractiveness 
to  medical  treatment,  thymectomy  was  done 
on  Dec.  15,  1967.  The  thymus  was  enlarged 
with  extension  of  its  lateral  lobes  up  into 
the  neck.  It  weighed  35  grams  ujion  re- 
moval (normal  for  this  age  is  24  grams). 
Histologically  the  specimen  was  normal. 
His  post-operative  course  was  uneventful. 
There  was  no  immediate  or  late  post-opera- 
tive improvement  in  his  ptosis  or  ocular 
muscle  palsy. 

The  patient  was  followed  in  out-pa- 
tient clinic  for  six  months.  There  was  no 
improvement.  Mestinon  now  caused  cholin- 


ergic reactions  in  previously  tolerated  doses, 
in  spite  of  the  use  of  atropine  sulfate.  No 
drugs  are  being  given  at  the  present  time 
and  the  patient  remains  as  before  surgery- 
no  better,  no  worse.  There  is  still  a bilateral 
ptosis  and  ophthalmoplegia. 

Discussion 

Myasthenia  gravis  is  rare  in  infants  and 
children. The  disease  seems 
more  prevalent  in  Negroes  in  our  own  and 
in  Dr.  Ford’s  clinic  and  in  the  age  range  of 
18  months  to  10  years.^ 

The  incidence  in  females  is  4.5  times 
higher  than  males  during  the  hrst  decade.^^ 
Those  reported  in  the  neonatal  period  are 
usually  a transient  illness  passively  trans- 
ferred from  an  affected  mother.^^’-"*  The 
prognosis  in  children  is  generally  poor  de- 
spite the  use  of  a large  variety  of  pharma- 
cologic agents  as  well  as  X-rays  and  thy- 
mectomy. Although  muscle  weakness  and 
dysphagia  are  frequently  benehtted  by  drug 
therapy,  ptosis  and  ophthalmoplegia  are 
the  most  refractory  symptoms.  The  period 
of  adolescence  is  a most  difficult  barrier. 

Thymectomy  has  been  done  with  thera- 
peutic beneht  mainly  in  adults  with  myas- 
thenia gravis  whose  response  to  medical 
regimen  had  been  unsatisfactory. 

In  1950,  Ritter  and  Epstein^i  reported 
a 9-year-old  child  who  died  about  4 months 
after  thymectomy  without  any  post-opera- 
tive beneht.  Thymectomy  was  of  no  avail 
in  the  case  of  a 14-year-old  girl,  reported 
by  Goya.®  The  youngest  patient  with  myas- 
thenia gravis  in  whom  thymectomy  had  a 
favorable  effect  was  a 25-month-old  girl  re- 
ported by  Sutin  and  Hewiston.-® 

The  most  encouraging  report  of  beneht 
from  thymectomy  in  children  with  myasthe- 
nia gravis  is  that  of  Keynes^^  who  cured 
14  of  21  children  (21/9  to  16  years)  so  that 
they  no  longer  needed  drugs.  In  reviewing 
the  study  of  78  patients  subjected  to  thymec- 
tomy in  the  report  of  Schwab  and  Leland,-- 
more  beneht  from  surgery  was  obtained  in 
female  than  male  patients  and  in  those  21 
to  30  years  of  age.  The  remission  rate  af- 
ter 31  years  of  age  was  very  low,  particular- 
ly in  males. 

Osserman  and  Genkins-®  hold  that  age 
rather  than  sex  is  the  major  factor  in  the 
selection  of  patients  for  thymectomy;  rela- 
tively young  patients  with  recent  onset  of 
symptoms  do  best.  Simpson’s“^  study,  on 


for  July,  1970 


<5 


the  other  hand,  showed  little  evidence  that 
better  operative  residts  are  obtained  in  the 
younger  and  female  group. 

The  child  presented  in  this  report  had 
ocular  myasthenia  which  started  with  ptosis 
of  the  right  lid  and  progressed  to  involve 
the  left  lid  and  then  all  of  his  extraocular 
muscles.  The  incidence  of  ocular  myasthen- 
ia varies  from  4.5%  to  29.7%.“^ 

Altliough  patients  with  myasthenia  gravis 
are  usually  referred  for  surgery  when  thy- 
moma is  present  regardless  of  the  severity 
of  the  disease, " " the  result  was  poor 

in  the  reports  of  Keynes, Schwab  and 
Leland--  and  Simpson.-®  In  the  report  of 
Kreel,  Osscrman,  Genkins  and  Kark,!®  the 
patients  with  thymic  hyperplasia  were  more 
benefitted  than  the  patients  with  thymoma. 

The  indications  for  thymectomy  in  my- 
asthenia gravis  given  by  Kreel,  et  ab®  were: 
I)  Thymoma,  all  patients:  2)  Benign  hyper- 
plasia, under  40  years  with  onset  less  than 
five  years  previously  and  relractory  to  medi- 
cation. According  to  Kreel,  et  al,^®  14  or  15 
thymectomized  patients  had  a dramatic, 
though  sometimes  transitory,  remission  of 
their  myasthenic  symptoms  immediately  af- 
ter recovery  from  anesthesia.  Our  patient 
had  no  such  remission. 

The  concomitant  presence  of  bronchial 
asthma,  non-cholinergic,  with  recurrent 
acute  attacks  in  our  case  may  be  an  import- 
ant part  in  the  refractory  resjjonse  to  medi- 
cal and  surgical  treatment.  In  the  report 
of  Kreel  ct  al,  the  only  mortality  among 
the  15  patients  operated  was  an  18-year-old 
girl  with  myasthenia  and  bronchial  asthma. 

In  adidts,  the  younger  the  ])atient,  the 
shorter  the  history,  the  better  the  response 
to  thymectomy.®'®  '®  However,  to  assess  the 
effect  of  thymectomy  as  a treatment  of  my- 
asthenia gravis  in  infants  and  children, 
there  should  be  a critical  review  of  a large 
number  of  cases.  The  rarity  of  this  disease 
in  children  puts  this  task  far  ahead. 

Summary 

A case  of  myasthenia  gravis  in  a 6-year- 
old  child  is  reported  with  an  unsatisfactory 
response  to  medical  and  surgical  treatment. 
Two  elements  are  considered  as  the  possible 
contributing  cause  of  failure  to  respond  to 
thymectomy  in  spite  of  having  had  a large 
thymus: 

1.  Concomitant  presence  of  non- 
cholinergic  bronchial  asthma: 

2.  Presence  of  ocular  myasthenia.  ◄ 


References 

1.  Blalock,  A.,  Mason,  M.  F.,  Morgan,  H.  J.,  and 
Riven,  S.  S.;  “Myasthenia  gravis  and  tumors 
of  thymic  region:  Report  of  a case  in  which 
tumor  was  removed.”  A/in.  Surg.,  110:544,  1939. 

2.  Bowman,  J.  R.:  “Myasthenia  gravis  in  young 
children.”  Pediatrics,  1:472,  1948. 

3.  Eaton.  L.  M.,  and  Clagett,  O.  T.:  “Recent  sta- 
tus of  thymectomy  in  the  treatment  of  myas- 
thenia gravis.”  Amer.  J.  Med.,  19:703,  1955. 

4.  Ford,  F.  R.:  Diseases  of  the  Nervous  System  in 
Infancy,  Childhood  and  Adolescence,  ed.  5. 
Springfield,  111.:  Charles  C.  Thomas,  p.  1261, 
1966. 

5.  Gerstle,  M.  Jr.:  “Myasthenia  gravis:  Remarks 
on  tlie  age  incidence:  Report  of  a case.”  Calif, 
and  West.  Med.,  30:113,  1929. 

6.  Goya,  N.  H.,  Matshumoto,  T.  M.,  Tshboi,  C.  Z., 
and  Seumiyoshi,  A.  N.:  “A  case  of  myasthenia 
gravis  without  the  validity  of  thymectomy.” 
.Saishin  Igaku.  21:1823,  1966. 

7.  Hatcher,  C.  R.,  Exarhos,  N.,  Logan,  W.  D.,  and 
.Vbhott,  O.  A.:  “Thymectomy  for  tumor  and 
myasthenia  gravis.”  Dis.  Chest,  52:350,  1967. 

8.  Henson.  R.  Stern,  G.  M.,  and  Thompson, 
V.  C.:  “Thymectomy  for  myasthenia  gravis.” 
Brain,  88:11,  1965. 

9.  Kawaichi,  G.  K.  and  Ito,  P.  K.:  “Myasthenia 
gravis:  Report  of  its  occurrence  in  a 21 -month- 
old-infant."  Amer.  J.  Dis.  Child.,  63:354,  1942. 

10.  Kennedy,  F.  S.,  and  Moersch,  F.  P.:  “Myas- 
thenia gravis:  A clinical  review  of  87  cases  ob- 
served between  1915  & early  part  of  1932.” 
Can.  Med.  Ass.  J.,  37:216,  1937. 

11.  Keynes,  G.:  “Investigations  into  thymic  dis- 
eases & tumor  formation."  Brit.  J.  Surg.,  42:450, 
1955. 

12.  Keynes,  G.  “Surgery  of  thymus  gland.”  Lancet, 
1:1197,  1954. 

13.  Keynes,  G.:  “The  surgery  of  thymus  gland.” 
Brit.  J.  Surg..  33:201,  1946. 

14.  Keynes,  G.:  “Surgical  treatment  of  myasthenia 
gravis. " Lancet.  1:739,  1946. 

15.  Kreel.  I.,  Genkins.  G.,  Osserman,  K.  E.,  Jacob- 
son, E.,  X:  Baronofsky,  I.  D.:  “Studies  in  myas- 
thenia gravis.”  Arch.  Surg.,  81:251.  1960. 

16.  Kreel,  I.,  Osserman,  K.  E.,  Genkins,  G.,  & Kark, 

E.:  “Role  of  thymectomy  in  the  manage- 
ment of  myasthenia  gravis.”  Ann.  Surg.,  165:- 
111,  1967. 

17.  Lahranche.  H.  G.,  & Jefferson,  R.  N.:  “Cong, 
myasthenia  gravis.”  Ped.,  4:16,  1949. 

18.  Levethan,  S.  T.,  Eried,  J.,  & Madonicke,  M. 
J.:  "Myasthenia  gravis:  Report  of  a case  in 
which  prostigmin  methylsulfate  was  used.” 
Amer.  J.  Dis.  Child.,  61:770,  1941. 

19.  Lieberman,  .\.  T.:  “Myasthenia  gravis  with 
acute  fulminating  onset  in  a child  5 years  old.” 
J.A.M.A.,  120:1209,  1942. 

20.  Osserman.  K.  E.  X:  Genkins,  G.:  “Studies  in 
myasthenia  gravis.”  New  York  J.  Med.,  61:2076, 
1961. 

21.  Ritter.  J.  .A..,  X:  Epstein,  N.:  “Some  observa- 
tions on  the  effect  of  various  therapeutic  agents, 
including  thymectomy  X:  .ACTH  in  a 9 year 
old  child.”  Amer.  J.  Med.  Sci.,  220:66,  1950. 

22.  Schwab,  R.  S.  X:  Leland,  C.  C.:  “Sex  X:  age  in 
myasthenia  gravis  as  critical  factors  in  inci- 
dence X:  remissions.”  J.A.M.A..  153:1270,  1953. 

23.  Simpson.  J.  “.An  evaluation  of  thymectomy 
in  myasthenia  gravis.”  Brain,  81:112,  1958. 

24.  Strickroot.  F.  L.,  Schaeffer,  R.  L.,  X:  Bergo, 
H.  I..:  “Myasthenia  gravis  occurring  in  an  in- 
fant born  of  a myasthenic  mother.”  J.A.M.A., 
120:1207.  1942. 

25.  Sutin,  G.  J.,  & Hewiston,  R.  P.:  “Myasthenia 
gravis  in  a 2 year  old  child  treated  by  thymec- 
tomy.” S.  Afr.  Med.  J.,  40:1002,  1966. 

26.  A'ahr,  M.  D.  X:  Davis,  T.  K.:  “Myasthenia  gravis: 
Its  occurrence  in  a 7 year  old  female  child.” 
/.  Pediat.,  25:218,  1944. 


46 


Illinois  Medical  Journal 


Medical  Progress 


Harvey  Kravitz,  M.D. 
Medical  Progress  Editor 


Conte  raporary 
Practices 


in 

Opiitiialmology 


“Our  sight  is  the  most  perfect  and  most  delightful  of  all  our  senses.  It  fills 
the  mind  ivith  the  largest  variety  of  ideas,  converses  until  its  ob]ects  at  the 
greatest  distance,  and  continues  the  longest  in  action  without  being  tired 
or  satiated  with  its  proper  enjoyments.” 

—Joseph  Addison  (The  Spectator)  1812 


By  John  G.  Bellows, 

Sight  is  man’s  most  jarecious  and  usefid 
means  of  sense  perception;  yet  it  is  a cruel 
irony  that  thousands  of  Americans  need- 
lessly become  blind  every  year.  Sight  en- 
ables man  to  probe  all  dimensions  and  dis- 
tances, whereas  the  other  senses  that  en- 
hance the  human  personality  are  effective 
only  through  actual  contact  or  close  prox- 
imity. 

Vision,  in  its  narrowest  and  broadest 
sense,  permits  man  to  explore  both  the 
near  world  and  to  reach  into  the  distant 
corners  of  the  universe.  Almost  85% 


John  G.  Bellows,  M.D., 
Ph.D.,  is  an  ophthalmologist, 
associate  professor  of  Oph- 
thalmology at  Northwestern 
University  Medical  School.  He 
is  on  staff  at  several  Chicago 
hospitals.  He  received  his 
M.D.  from  the  University  of 
Illinois,  and  an  M.S  and  Ph.D. 
from  Northwestern  Univer- 
sity. He  took  his  internship  and  residency  at 
Cook  County  Hospital  and  is  the  author  of 
two  hooks  in  his  field  as  well  as  more  than 
80  papers.  Dr.  Bellows  is  a founder  of  the 
Society  of  Cryosurgery  and  is  editor  of  Annals 
of  Ophthalmology. 


M.D.,  Ph.D. /Chicago 

of  our  knowledge  of  the  outside  world  is 
gained  through  visual  perception.  Man  uti- 
lizes this  visually  acquired  information  to 
ascertain  facts,  to  form  opinions,  and  to 
make  judgments. 

The  knowledge  explosion  that  continues 
apace  in  all  of  medicine  is  perhaps  nowhere 
more  evident  and  dramatic  than  in  oph- 
thalmology. Even  the  ophthalmologist  with 
an  extensive  practice  is  hard-pressed  to  keep 
abreast  of  the  continuing  advances  in  this 
dynamic  held.  It  must  be  conceded  that 
the  physician  has  a tridy  difficult  problem 
because  he  is  concerned  with  keeping  cur- 
rent in  many  helds.  However,  some  knowl- 
edge of  the  latest  work  in  ophthalmology 
will  be  most  valuable  because  the  physi- 
cian is  frequently  the  hrst  to  be  consulted 
and  many  eye  conditions  recjuire  early  and 
vigorous  treatment.* 

O 

The  well  informed  physician  should  be 
able  to  administer  proper  treatment,  coun- 
sel and  advice  for  some  ocular  problems 

*Writi?2g  in  the  June,  1970  Annals  of  Ophthalmol- 
ogy, Dr.  Morris  Fishhein  cites  a pertinent  observa- 
tion by  Dr.  Francis  Head  Adler:  "Of  all  the  spe- 
cialties, ophthalmology  is  nearest  to  general  prac- 
tice.’’ 


for  July,  1970 


41 


and  diseases  and  to  recognize  his  limitations 
in  managing  other  eye  diseases  requiring 
specialist  care.  Although  it  would  be  im- 
possible to  describe  in  one  paper  all  of  the 
important  ophthalmologic  advances  of  re- 
cent years,  the  information  that  is  of  par- 
ticular significance  and  interest  to  the  in- 
ternist and  general  physician  will  be  de- 
scribed. 

How  We  See 

No  longer  tenable  is  the  old  belief  that 
sight  is  the  result  of  an  object  forming  an 
image  on  the  retina  which  is  transmitted 
to  the  visual  cortex  of  the  brain  to  produce 
a “picture.”  The  role  of  the  brain  in  the 
visual  process  is  now  known  to  be  far  more 
complex  and  to  be  more  closely  analagous 
to  data  processing  than  to  the  formation  of 
an  actual  image. ^ 

The  visual  image  of  an  object  per  se 
goes  no  further  than  the  retina.  The  visual 
cortex  of  the  brain  receives  nerve  impulses 
first  generated  in  the  retina;  these  are  de- 
coded in  the  brain.  The  pathway  for  the 
visual  impulses  which  begin  in  the  photo- 
receptors of  the  retina  is  along  the  optic 
nerve.  At  the  chiasma  the  optic  nerve  sep- 
arates into  two  halves,  with  the  nasal  halves 
crossing  over.  Thus  the  fibers,  from  the 
lateral  half  of  one  eye  and  the  nasal  half 
of  the  other  eye,  unite  to  form  the  optic 
tract  which  is  the  pathway  that  leads  the 
stimuli  to  the  lateral  geniculate  body.  Here 
the  receptive  ganglion  cells  receive  the  im- 
pulses from  the  homologous  halves  of  the 
retinas.  At  this  junction,  chemical  sub- 
stances are  released  producing  impulses 
which  are  transmitted  by  means  of  the  optic 
radiations  to  the  visual  cortex  of  the  brain. 
These  impulses  travel  at  the  rate  of  about 
100  meters  per  second.  The  visual  cells  of 
the  brain  which  are  in  the  calcarine  fissure 
of  the  cerebral  cortex  receive  these  impulses 
and  immediately  proceed  with  decoding  the 
stimuli.  In  a method  resembling  data  proc- 
essing the  visual  cells  yield  “bits”  of  data 
which  are  conceptualized  by  the  individual 
in  the  form  of  the  image  he  sees. 

Not  only  visual  information  arises  from 
the  activity  of  the  stimulated  cerebral  visual 
cells  but  also  responses  to  suit  the  occasion 
are  generated.  In  lower  animals  the  most 
important  responses  center  around  survival, 
and  the  reactions  are  instinctive.  Sight  plays 
a larger  role  in  man  than  in  animals  be- 
cause man  has  developed  binocular  vision 


with  depth  perception.  These  capabilities 
enable  man  to  judge  distance.  “Man  sees 
a landscape,  but  the  lion  smells  it,”  is  an 
old  adage.  Conversely  man’s  ability  to 
smell  and  to  pinpoint  the  source  of  an  odor 
is  far  inferior  to  that  of  many  animals.  The 
superiority  of  man  over  lower  animals  de- 
pends in  a large  measure  on  his  ability  to 
see  better  and  also  to  build  up  experiences. 
As  a result  of  his  siqrerior  sight,  man  en- 
joys the  greater  powers  of  recognition,  mem- 
ory, habit,  logic,  evaluation,  and  judgment. 
The  stereoscopic  qualities  of  his  vision  and 
the  ability  to  converge,  enabling  man  to 
develop  manual  and  other  skills,  have  re- 
sulted in  the  growth  of  his  brain  and  his 
power  to  think. 

Bacterial  Infections  of  the  Eye 

Lhitil  about  1945,  infections  of  the  eye 
by  Neisseria  gonorrhoeae,  Corynebacteria 
diphtheriae  and  Diplococcus  pneumoniae 
were  common  causes  of  blindness.  Since  that 
time  loss  of  vision  from  these  organisms  has 
been  virtually  eliminated. 

Now  the  staphylococcus  group  of  organ- 
isms, especially  those  which  produce  peni- 
cillinase and  those  which  develop  resistance 
to  the  common  antimicrobial  agents,  are  of 
growing  concern  to  the  ophthalmologists. 
Drug  resistance  plays  a greater  role  in  the 
infections  caused  by  staphlococci  than  in 
those  caused  by  any  other  organism. 

Resistant  staphylococci  are  frequent  in- 
habitants in  hospitals,  especially  among 
patients,  attendants,  nurses,  residents,  and 
the  attending  staffs  of  physicians.  The  re- 
sistant patterns  vary  from  hospital  to  hos- 
pital depending  upon  the  most  common 
antibacterial  agents  used  in  the  particular 
institution.  The  patient  may  actually  be 
infected  in  the  hospital;  this  has  been 
demonstrated  in  patients  whose  conjunctiva 
were  free  of  pathogenic  organisms  on  en- 
tering the  hospital  but  whose  cultures  two 
or  three  days  later  showed  them  to  be  har- 
boring staphylococci  in  their  conjunctivas. 
It  is  conceivable  that  if  these  patients  un- 
dergo intraocular  suigery  the  ubiquitous 
staphylococci  may  invade  the  wound  and 
cause  an  intraocular  infection. 

In  many  instances  it  is  impossible  to  iden- 
tify the  infectious  agent  causing  the  intra- 
ocular infection.  When  infection  occurs, 
the  eye  surgeon  employs  an  antimicrobial 
agent  that  is  not  commonly  used  at  the 


48 


Illinois  Medical  Journal 


hospital.  He  chooses  an  antibiotic  that  has 
a broad  spectral  base  to  attack  gram  nega- 
tive organisms  that  may  also  be  present. 
For  these  reasons,  eye  surgeons  presently 
substitute  for  penicillin  one  of  the  follow- 
ing agents:  methicillin,  erythromycin,  colis- 
tin,  gentamycin,  sodium  cephalothin  and 
cephaloridine. 

External  Viral  Infections  of  the  Eye 

In  this  country  the  most  common  exo- 
genous viral  infections  of  the  eye  are  her- 
pesvirus keratitis  and  infections  caused  by 
the  adenovirus  types  3,  7,  and  8.  The  ade- 
novirus infections  of  the  eye  are  self-limit- 
ing and  cause  no  visual  impairment. 

Herpesvirus  infection  has  been  known 
medically  for  centuries.  The  word  herpes 
is  of  Greek  origin  meaning  “creep.”  Neat  ly 
100%  of  the  population  harbor  the  virus. 
The  tendency  for  latency  and  repetitive 
eruptions  are  well  known  to  the  physicians. 
When  herpesvirus  infection  involves  the 
cornea  (herpesvirus  keratitis)  it  may  cause 
serious  impairment  of  sight.  This  viral  in- 
fection of  the  cornea  is  now  the  leading 
cause  of  corneal  scarring,  having  replaced 
trauma  and  bacterial  infections  that  were 
formerly  the  chief  causes  of  impaired  vision 
from  corneal  scarring.  An  acute  herpetic 
eruption  of  the  cornea  may  be  precipitated 
by  exposure  to  sunlight,  wind,  or  the  appli- 
cation of  eye  drops  containing  steroids.  The 
high  fevers  accompanying  malaria  may  also 
precipitate  a herpesvirus  eruption.  This 
type  of  infection  is  of  importance  to  the 
military  ophthalmologist  in  Vietnam  as 
well  as  to  civilian  physicians  treating  ma- 
larial infected  American  veterans  who  may 
have  recurrent  high  fevers.  The  tendency 
of  herpesvirus  keratitis  to  recur  and  to  be- 
come chronic  frequently  leads  to  the  in- 
volvement of  the  corneal  stroma  with  per- 
manent corneal  scarrinsr. 

O 

Fortunately,  in  recent  years  the  use  of 
IDU  (5-iodo-2’  deoxyuridine)  and  the  new- 
er antiviral  agents  have  been  a major  con- 
tribution in  combating  herpesvirus  kera- 
titis. Another  new  advance  in  the  treatment 
of  this  disease  is  the  application  of  low 
temperature  by  means  of  a cryoprobe  ap- 
plied to  the  herpes  lesion  of  the  cornea.  Re- 
covery rates  following  cryotherapy  have 
been  reported  to  be  over  95%,  in  contrast 
to  the  50-70%  recovery  rate  with  antiviral 
agents. 2 Even  more  recently,  the  use  of  in- 


terferon inducers  offer  great  hope  for  pre- 
venting visual  loss  from  this  disease. 

Transfer  of  Maternal  Viral  Infections 
to  the  Fetus 

Viral  infections  with  ocular  involvement 
can  be  transferred  from  the  mother  to  the 
embryo  or  fetus  and  result  in  very  serious 
problems.  Rubella,  rubeola,  and  cytomega- 
lic inclusion  diseases  are  of  greatest  im- 
portance in  this  regard. 

An  infection  of  the  embryo  in  its  early 
days  of  development  will  cause  more  serious 
malformations  and  even  a miscarriage.  It 
follows  that  infections  later  in  pregnancy, 
when  most  of  the  organs  have  already  been 
formed,  will  produce  less  serious  effects. 
A miscarriage  or  a stillbirth  may  occur  even 
when  the  mother  has  fully  recovered.  Oc- 
casionally the  mother  may  have  a very 
slight  infection  which  appears  insignificant, 
or  she  may  not  even  be  aware  that  she  has 
had  an  infection,  but  at  birth  the  fetus 
may  show  serious  eye  malformations  as 
well  as  marked  defects  of  the  heart  and 
other  parts  of  the  body. 

Early  recognition  of  the  infection  in  the 
mother  enables  the  physician  to  alert  the 
parents  to  the  possibility  of  fetal  malfor- 
mations and  even  its  death.  Some  physi- 
cians employ  gamma  globulin  although  its 
value  is  questionable.  The  real  hope  for 
the  elimination  of  the  rubella  virus  as  a 
factor  in  producing  ocular  defects  lies  in 
immunization  programs  with  vaccines. 

PLT  Group  of  Atypical  Viruses 

In  the  Ehiited  States  eye  infections  by 
the  psittacosis-lymphogranuloma-trachoma 
group  of  atypical  viruses  have  become  rare. 
However,  the  PLT  group  is  still  a major 
cause  of  blindness  in  underdeveloped 
countries.  Even  in  these  regions,  trachoma, 
the  most  important  disease  of  the  group, 
could  be  eliminated  if  those  governments 
made  concerted  efforts  to  treat  patients  with 
local  and  systemic  sulfonamides,  tetra- 
cyclines, streptomycin,  rifampin  and  other 
antibiotic  agents. 

Glaucoma 

It  is  estimated  that  two  million  persons 
in  the  United  States  over  the  age  of  35 
are  threatened  with  incurable  blindness 
from  glaucoma.  If  untreated,  glaucoma 
destroys  the  optic  nerve.  More  than  half 


for  July,  1970 


49 


ol  the  potential  glaucoma  patients  are  un- 
aware of  the  presence  of  the  disease.  In 
most  instances  there  is  autosomal  dominant 
inheritance. 

It  is  advisable  that  physicians  test  the 
intraocidar  jrressure  when  performing  rou- 
tine physical  examinations  on  adults.  The 
test  and  equipment  merely  call  for  a sur- 
face anesthetic  and  an  inexpensive  tonom- 
eter. Ophthalmologists  or  eye  residents  will 
gladly  demonstrate  this  simple  test  to  a phy- 
sician upon  request. 

I'he  most  common  forms  of  this  disease 
in  adults  are  simple  or  open-angle  glau- 
coma and  acute  or  narrow-angle  glaucoma. 
Narrow-angle  glaucoma  usually  requires 
surgery,  and  this  shoidd  be  performed  early 
in  the  course  of  the  disease  before  ocular 
damage  occurs.  On  the  other  hand,  open- 
angle  glaucoma  is  readily  controlled  by 
medication. 

Pilocarpine  is  the  chief  drug  employed 
in  the  treatment  of  glaucoma  and  was  the 
first  direct-acting  cholinergic  compound  to 
be  used  in  glaucoma  therapy.  A one  per- 
cent solution  of  this  agent  will  frecpiently 
constrict  the  pupil  lor  a jreriod  of  five  to 
six  hours.  If  pilocarpine  fails  to  control  the 
intraocular  tension  the  ophthalmologist 
will  prescribe  either  the  short-lasting  phy- 
sostigmine  or  the  long  lasting  carbachol, 
isoflurophat,  echothiophate,  and  demecar- 
ium  bromine. 

If  the  administration  of  miotics  and 
epinejrhrine  does  not  control  the  ojten- 
angle  glaucoma,  the  surgeon  will  then  at- 
tempt to  reduce  the  rate  of  aqueous  for- 
mation. In  mild  types  of  this  disease  the 
carbonic  anhydrase  inhibitors  (acetazola- 
mide,  methazolamide,  dichlophenamide  and 
ethoxy/olamide)  will  aid  in  controlling  the 
intraocular  pressure.  If  these  agents  are  in- 
elfective  the  surgeon  may  employ  cryocy- 
clotherajjy.  This  painless  procedure  (cryo- 
cyclotherapy)  may  even  be  jrerformed  as  an 
olfice  procedure  ret|uiriug  only  a few  drojis 
of  a sm  lace  anesthetic.  The  techni()ue  is 
simide.  The  ophthalmologist  places  the  tip 
of  the  cold  applicator  (at  about  — 100°C) 
to  the  region  of  the  ciliary  processes  and 
ciliary  body  (4  to  5mm  from  the  limbus  of 
the  cornea).  Freezing  at  very  low  tempera- 
tures causes  atrophy  of  the  ciliary  body  and 
ciliary  processes  and  thereby  reduces  the 
amount  of  aqueous  formation.  This  cryo- 
surgical procedure  is  particularly  effective 
in  elderly  patients  in  whom  the  ciliary  body 


and  processes  are  already  partially  atro- 
phied. 

The  Crystalline  Lens 

One  of  the  major  causes  of  impaired  vi- 
sion in  adults  over  65  years  of  age  is  cata- 
ract. In  recent  years  a great  amount  of  in- 
formation has  been  developed  on  the  bio- 
chemistry of  the  clear  and  cloudy  crystal- 
line lens.  In  addition,  the  electron  micro- 
scope has  been  of  great  value  in  estab- 
lishing the  architecture  of  the  lens. 

The  lens  is  an  excellent  osmometer. 
Wdren  excessive  glucose,  drugs  or  toxins 
reach  the  aqueous  humor  its  osmotic  pres- 
sure is  increased.  This  withdraws  water 
from  the  lens.  When  normal  osmotic  levels 
are  restored,  the  increased  concentration 
of  the  aforementioned  substances  attracts 
water  to  enter  the  lens.  These  osmotic 
changes  in  the  lens:  dehydration,  hydra- 
tion, and  return  to  normal  are  accompan- 
ied by  corresponding  transitory  refractive 
changes:  myopia,  hyperopia,  and  restora- 
tion of  the  normal  refractive  state. 

The  lens  which  originates  from  the  sur- 
face ectoderm  differs  from  the  skin  in  that 
the  oldest  cell  hbers  are  in  the  center  and 
the  youngest  cell  hbers  are  most  superhcial. 
Since  lens  hbers  remain  within  the  lens  cap- 
sule throughout  the  life  of  the  individual 
any  traumas  in  the  broadest  sense,  i.e.,  meta- 
bolic disturbances,  toxins  and  radiation, 
leave  a permanent  mark.  These  changes 
make  the  lens  an  excellent  sensitometer 
and  chronometer.  The  mark  in  the  form 
of  an  opacity  corresponds  to  the  time  in 
life  when  the  injury  occurred.  From  this, 
the  exjterienced  ophthalmologist  is  able  to 
estimate  the  approximate  date  of  the  opac- 
ity with  the  biomicroscope.  The  technique 
of  dating  the  opacity  in  the  lens  is  termed 
phakochronology  (Gk.  phakos  = lens— 
chronos  time).  This  technique  is  of  spe- 
cial inqrortance  in  settling  medicolegal  dis- 
putes. 

Cataract  Surgery 

In  recent  years  many  dramatic  improve- 
ments have  made  cataract  surgery  simple 
aud  sale  so  that  jratients  no  longer  need 
to  lear  this  type  of  surgery. 

Eliminating  the  technical  details  of  sur- 
gery, the  most  important  improvements 
have  been  1)  cryoextraction  which  permits 
the  surgeon  to  obtain  a superior  grasp  on 


50 


Illinois  Medical  Journal 


the  lens,  practically  eliminating  capsular 
ruptnre  and  permitting  removal  of  the  lens 
throngh  a smaller  incision;  2)  physical  or 
enzymatic  zonulolysis  to  free  the  lens  from 
its  attachments;  the  latest  development  in 
this  area  has  been  hydrokinetic  zonulolysis 
in  which  the  surgeon  uses  sterile  balanced 
salt  solution  to  rupture  the  zonules;  3)  im- 
proved needles  and  suturing  materials,  al- 
lowing the  stirgeon  to  close  the  wound  and 
to  make  the  anterior  chamber  air-and- 
water-tight;  this  permits  early  ambnlation; 
4)  neuroleptanalgesia  prodticed  by  the 
newer  drugs  places  the  patient  in  a state  of 
basal  anesthesia;  this  permits  the  surgeon 
to  operate  on  a trancpnl  and  cooperative 
patient. 

I’hus  cataract  snrgery  has  become  so  re- 
fined and  safe  that  even  the  very  infirm  and 
elderly  patient  may  have  his  sight  restored 
once  again  to  see  the  faces  of  his  family 
and  friends  and  to  resume  the  normal  ac- 
tivities within  his  physical  capabilities. 

Retinal  Detachment 

Retinal  detachment  is  the  separation  of 
the  retina  from  the  underlying  pigment 
layer  resnlting  from  a tear  or  a hole  in 
the  retina.  These  holes  or  tears  usually  re- 
sult from  degenerative  or  myopic  thinning 
of  the  retina.  Fluid  enters  through  the 
retinal  hole,  raising  the  retina  and  pro- 
ducing loss  of  vision. 

Surgery  is  the  only  effective  treatment, 
yielding  successfid  repairs  in  80-90%.  Un- 
fortunately, the  surgical  result  is  not  al- 
ways accompanied  by  a restoration  of  the 
visual  acuity  to  its  former  state,  especially 
if  the  macula  area  has  been  involved.  The 
good  surgical  results  are  attributable  to 
Itetter  materials  and  implants  and  im- 
proved technical  procedures  inchiding  the 
application  of  low  temperature  instead  of 
diathermy  to  produce  adhesive  chorioreti- 
nitis to  seal  the  holes. 

Ocular  Complications  of  Diabetes 
Mellitiis 

Better  medical  management  of  diabetes 
extending  the  life  span  of  the  diabetic  has 
led  to  an  increase  in  the  incidence  of  ocu- 
lar complications.  The  two  major  ocular 
complications  are  diabetic  retinopathy  and 
cataract. 

lire  incidence  of  diabetic  retinopathy 
increases  with  the  duration  of  the  disease. 


Thus,  if  the  onset  of  the  diabetes  occurs  in 
a young  individual,  retinal  changes  will 
likely  develop  within  a period  of  16  to  18 
years.  Similar  changes  occur  in  the  vessels 
of  the  kidney  and  other  organs.  All  forms 
of  treatment  are  relatively  ineffective,  in- 
cluding ablation  of  the  hypophysis,  the  nse 
of  lipotropic  agents,  vitamin  therapy,  and 
ratlical  changes  in  the  diet.  Some  ophthal- 
mologists report  that  sealing  the  areas  of 
retinal  leakage  by  photo-coagulation  re- 
duces the  edema  of  the  macula  and  im- 
proves the  visual  actiity.  Other  ophthal- 
mologists doubt  the  value  of  photocoagtda- 
tion.  Recently  Fabrykant  and  his  co-workers 
reported  that  a high-protcin-low-fat  diet 
together  with  carbazochrome  (.Vdrenosem 
Silicylate)*  and  anabolic  steroids  will  catise 
an  improvement  in  the  retina  and  in  the 
visual  acinty.'^ 

Diabetic  cataract  is  seen  only  in  juvenile 
diabetics.  In  older  individtials  the  cataracts 
that  form  are  indistinguishable  Iroin  the 
ordinary  senile  cataracts.  The  treatment  of 
cataract  is  surgical  removal.  The  results  in 
diabetics  depend  upon  the  condition  of  the 
blood  vessels  of  the  iris  and  retina.  In  the 
absence  of  retinal  involvement  and  rue- 
bosis  irides,  cataract  surgery  in  diabetics 
offers  no  special  problems. 

Vascular  Diseases  of  the  Retina 

Pathological  changes  in  the  retinal  vas- 
cnlature  occtir  not  only  in  diabetes  mellitus 
but  are  also  common  in  hypertension  and 
arteriolosclerosis.  The  importance  of  exam- 
ining the  ftindtis  of  the  eye  is  that  hyper- 
tensive and  arteriolsclerotic  changes  ob- 
served in  the  retina  are  paralleled  by  simi- 
lar alterations  in  the  renal  vessels.  Thns  the 
physician  obtains  valnable  information  as 
to  the  state  of  the  vessels  in  the  kidney  by 
ophthalmoscopic  examinations. 

There  are  four  stages  of  hyjjertensive 
vascidar  disease:  In  the  early  stage,  hyper- 
tensive arteriolo-retinal  vessels  are  some- 
what narrower  than  normal;  they  will  ap- 
pear “coppery.”  In  stage  II  the  attennation 
of  the  arteriolar  vessels  becomes  more  pro- 
nounced. Focal  areas  of  marked  constric- 
tions indicate  local  vascular  spasms.  In 
stage  III,  edema  and  flame-shaped  hemor- 
rhages make  their  appearance.  Finally,  stage 
IV  shows  the  additional  feature  of  edema 
of  the  optic  disc. 

*SEMED  Pharmaceuticals. 


for  July,  1970 


51 


In  a recent  report,  Wendland  states  that 
the  degree  of  hypertension  is  more  import- 
ant than  age  as  a factor  in  the  production 
of  arteriolosclerosis.  Diabetes  mellitns,  if 
present,  accelerates  the  rate  of  progression 
of  arteriolosclerosisd 

Venous  obstruction.  Obstruction  of  the 
central  retinal  vein  may  come  on  with  dra- 
matic suddenness  with  almost  complete 
blindness.  The  ophthalmoscopic  findings 
are  so  distinctive  that,  when  associated  with 
sudden  loss  of  vision,  they  make  the  diag- 
nosis unmistakable.  The  physician  viewing 
the  fundus  with  an  ophthalmoscope  will 
observe  the  marked  dilation  of  the  veins 
accompanied  by  “brush-stroke”  hemor- 
rhages in  the  retina.  If  only  a tributary 
vessel  is  involved  the  above  findings  are 
localized  in  that  area. 

Until  recent  years,  treatment  was  limited 
to  the  use  of  anticoagulants  and  the  occa- 
sional use  of  hbrinolytic  enzymes  with  gen- 
erally poor  results.  Recently  an  important 
advance  in  therapy  was  reported  when  Rad- 
not  demonstrated  that  the  intravenous  ad- 
ministration of  dextran  produced  a striking 
rate  of  recovery.'’’  This  was  especially  true 
if  treatment  was  begun  early.  It  is  now  rec- 
ognized that  a great  many  strokes  are  ac- 
tually the  result  of  carotid  occlusion. 
Among  the  early  warning  symptoms  of  im- 
pending closure  of  the  carotid  artery  are 
signs  of  transient  ipsilateral  loss  of  vision 
and  even  homonymous  hemianopsia.  These 
ocidar  symptoms  may  be  accompanied  by 
transitory  hemiplegia.  When  these  signs  are 
present  it  is  imperative  that  ophthalmody- 
namometry be  employed  to  determine  the 
patency  of  the  carotid  arteries. 

Ophthalmodynamometry  may  be  per- 
formed either  by  pressure  on  the  globe  or 
by  suction. '■>  With  the  ophthalmoscope  the 
physician  observes  the  point  at  which  pul- 
sations begin  in  the  retinal  arterioles;  this 
reading  indicates  the  diastolic  pressure.  The 
procedure  is  continued  until  the  retinal  ves- 
sels cease  to  pulsate;  this  reading  indicates 
the  systolic  pressure.  A signihcant  difference 
in  the  values  of  the  two  sides  indicates 
impending  carotid  obstruction. 

Treatment  consists  of  the  administration 
of  anticoagulant  drugs  before  the  carotid 
artery  becomes  occluded.  If  necessary,  sur- 
gical intervention  may  restore  normal 
blood  flow  to  the  brain  and  eye. 


Ocular  Toxicity  of  Drugs 

Numerous  drugs  have  a toxic  effect  upon 
the  eye  either  when  applied  topically  or 
when  used  systemically.  The  harmful  effects 
of  prolonged  local  applications  of  common- 
ly used  eye  drops  which  are  generally  con- 
sidered harmless  has  long  been  known.  This 
is  especially  true  when  the  epithelium  has 
been  denuded  by  trauma  or  extrusion  as  a 
result  of  an  infection. 

In  most  cases,  a physician  is  well  advised 
to  treat  a simple  corneal  abrasion  due  to 
trauma  by  merely  lavaging  the  eye,  apply- 
ing a patch,  and  observing  the  eye  daily. 
In  many  instances  the  eye  usually  heals 
without  further  treatment.  On  the  other 
hand,  repetitive  applications  of  eyedrops 
in  the  presence  of  an  epithelial  defect  may 
inhibit  healing  and  cause  permanent  scar- 
ring. Drugs  that  inhibit  healing  and  pro- 
duce permanent  scarring  in  the  presence 
of  a corneal  abrasion  include  topical  anes- 
thetics, silver  proteinate,  zinc  sulphate,  sul- 
fonamides and  antiviral  agents. 

The  physician  should  be  especially  cau- 
tious when  prescribing  eye  drops  contain- 
ing corticosteroids  because  their  prolonged 
use  may  lead  to  increased  intraocular  pres- 
sure or  precipitate  an  acute  attack  of  her- 
pesvirus keratitis.  It  is  also  known  that  long- 
term application  of  certain  miotics  may 
produce  lens  opacities.  Finally,  alpha  chy- 
motrypsin,  which  is  used  by  some  in  cata- 
ract surgery,  may  cause  glaucoma  and 
clouding  of  the  cornea. 

Systemic  drugs.  The  prolonged  systemic 
use  of  corticosteroids  may  produce  cata- 
racts. Optic  atrophy  and  loss  of  vision  has 
followed  the  use  of  quinine.  Chloroquine, 
used  in  the  treatment  of  malaria,  arthritis- 
and  lupus  erythematosus  may  be  deposited 
on  the  corneal  epithelium.  Frequently  a 
more  serious  and  irreversible  complication 
in  the  form  of  pigmentary  degeneration  of 
the  retina  occurs.  Common  psychotherapeu- 
tic agents  such  as  the  phenothiazine  drugs 
may  produce  retinal  changes  as  well  as  de- 
posits on  the  cornea  and  lens.  Digitalis  in- 
toxication producing  blurred  vision  and 
central  scotomas  has  been  reported;  recov- 
ery follows  the  discontinuance  or  reduction 
of  the  cjuantity.  Oral  contraceptives  have 
been  reported  to  have  a significant  relation- 
ship to  thrombophlebitis  in  the  legs  and 
elsewhere  and  have  been  frequently  associat- 
ed with  pulmonary  embolism.  Less  known 


52 


Illinois  Medical  Journal 


are  the  ocular  complications  either  as  a re- 
sult of  cerebrovascular  accidents  or  a result 
of  neuro-ocular  involvement  producing 
optic  neuritis  and  extra-ocular  muscle  pa- 
resis tv'ith  diplopia.  Ethambutol,  a drug 
used  in  the  treatment  of  pidmonary  tuber- 
cidosis,  may  produce  involvement  of  the 
neuro-optic  pathways. 

Chemical  Burns 

In  these  days  of  violence  chemical  burns 
of  the  eye  are  becoming  more  common. 
Mace,  used  by  law  enforcement  officers,  can 
cause  chemical  burns  of  the  eye.  Intentional 
or  accidental  alkali  and  acid  burns  call  for 
immediate  emergency  measures.  The  victim 
should  immediately  flush  the  eye  with 
water  or  any  inert  fluid  that  is  available, 
such  as  milk,  to  remove  the  chemical  agent. 
The  time  interval  that  elapses  before  la- 
vage is  performed  is  frequently  the  most 
important  factor  that  determines  the  de- 
gree of  damage  that  follows  a chemical 
burn.  The  author  treated  a woman  who 
had  been  burned  by  lye  deliberately  thrown 
into  her  eyes.  She  had  the  presence  of  mind 
to  reach  for  a milk  bottle  on  a nearby  door- 
step. She  poured  the  contents  into  her  eyes 
within  a matter  of  seconds.  Undoubtedly 
the  immediate  washing  out  of  the  toxic 
material  contributed  to  the  lack  of  per- 
manent damage. 

It  is  generally  known  that  alkalies  cause 
far  more  damage  to  the  eye  than  acids. 
Since  it  is  also  known  that  it  requires  a 
longer  period  of  time  to  restore  the  normal 
pH  of  the  cornea,  washing  with  water  (or- 
dinary tap  water  will  do)  should  be  carried 
on  for  at  least  thirty  minutes.  Further 
treatment  depends  upon  the  amount  of 
damage  sustained  by  the  cornea,  conjunc- 
tiva and  the  lids.  Necrosis  of  these  tissues 
frequently  recjuires  special  therapy  includ- 
ing surgical  procedures. 

Eyeliner  applied  to  the  lashes  by  women 
causes  a chronic  conjunctivitis  and  pigmen- 
tation of  the  conjunctiva.  Biopsy  of  the 
pigmented  conjunctiva  shows  microscopic- 
ally dense  infiltration  with  lymphocytes  and 
macrophages  containing  pigmented  gran- 
ules. 

Dyslexia 

A deficiency  or  disturbance  in  the  ability 
to  read  is  termed  dyslexia.  Poor  readers  and 
children  with  true  dyslexia  are  frequently 


brought  to  the  physician  for  examination 
and  advice. 

Ordinarily  children  learn  to  read  either 
by  recognizing  an  entire  word  (the  “look- 
say”  method)  or  by  the  arrangement  of  the 
individual  letters  and  their  sound  (the 
“phonics  method”).  Some  children  use  a 
combination  of  both  methods  to  learn  to 
read. 

Dyslexia  may  be  manifested  in  the  fol- 
lowing ways: 

1)  The  child  cannot  recognize  the  printed 
word,  but  he  understands  its  meaning 
when  the  word  is  spoken; 

2)  The  child  recognizes  and  understands 
the  printed  word,  but  not  the  meaning 
when  it  is  spoken; 

3)  The  child  recognizes  individual  letters 
but  cannot  put  them  together  to  form 
a word; 

4)  The  child  knows  the  word  but  cannot 
recognize  the  individual  letters; 

5)  The  child  is  able  to  read  and  under- 
stand the  printed  word  and  can  hear 
and  understand  the  spoken  word,  but 
he  cannot  associate  one  with  the  other. 

The  pediatrician  confronted  with  a young 
child  having  reading  difficulties  should  as- 
sume the  leadership  of  a multi-disciplinary 
team  comprising  specially  trained  teachers, 
psychologists,  and  social  service  workers. 
The  role  of  the  ophthalmologist  is  to  de- 
termine the  presence  or  absence  of  ocular 
defects  or  abnormalities  which  might  be 
contributing  factors.  The  otologist  and  the 
psychologist  should  determine  the  status 
of  the  child’s  hearing  and  intelligence.  The 
social  workers  should  search  for  family 
problems,  disadvantageous  cultural  climate, 
poor  teaching,  or  emotional  disturbances 
that  may  play  a role  in  the  child’s  reading 
deficiency. 

Amblyopia 

Strabismus  or  deviation  of  the  eye  pres- 
ent after  the  sixth  month  of  life  should 
be  treated  promptly  if  amblyopia  is  to  be 
avoided.  In  unilateral  deviation,  the  infant 
may  use  one  eye  to  see  and  suppress  vision 
in  the  other.  In  such  instances,  the  squint- 
ing eye  will  not  develop  properly.  Patching 
the  good  eye  must  be  prescribed  early  to 
force  the  child  to  use  the  squinting  eye 
to  avoid  irreparable  damage. 

Hubei  and  Wiesel  recently  demonstrated 
in  the  cat  that  occlusion  of  one  eye  caused 


for  July,  1970 


53 


a sharp  reduction  in  the  actual  number  of 
visual  cells  in  the  retina,  the  geniculate 
body,  and  the  striate  area  of  the  cortex.  Af- 
ter three  months  of  occlusion,  recovery  or 
improvement  did  not  occur.'  Similarly  an 
infant  with  a deviating  eye  and  total  sup- 
pression that  is  untreated  until  the  child 
is  4 or  5 years  of  age  will  rarely  have  more 
than  20/200  visual  acuity.  On  the  other 
hand,  a child  with  normal  sight  up  to  6 
or  8 years  of  age  who  develops  a paralytic 
or  non-paralytic  strabismus  retains  his  sight, 
no  matter  how  long  the  eye  remains  de- 
viated. The  physician  must  remember  that 
a child  does  not  outgrow  a squinting  eye 
and  that  very  early  therapy  is  necessary  to 
avoid  andrlyopia. 

Emerging  Developments  in 
Ophthalmology 

The  dynamic  nature  of  ophthalmology  is 
nowhere  more  apparent  than  in  the  stream 
of  new  ideas  and  developments  that  are 
constantly  being  presented  for  considera- 
tion. Among  the  most  noteworthy  develop- 
ments, briefly  mentioned,  are: 

• Ophthalmologists  have  begun  to  cjues- 
tion  the  belief  of  lighting  engineers  that 
“the  most  light  is  the  best  light.”  Eye  phy- 
sicians now  report  that  over-illumination 
may  be  harmfid  to  the  retina. 

• Keratoprostheses.  Patients  almost  blind 
from  diseases  of  the  cornea  are  treated  by 
the  imjilantation  of  an  acrylic  lens  in  the 
cornea.  This  frequently  results  in  the  res- 
toration of  nsefnl  vision. 

• New  methods  to  help  the  blind.  New 
devices  are  being  developed  with  the  hope 
that  the  blind  may  regain  1)  some  measure 
of  restored  visual  imagery  or  2)  some  sub- 
stitute for  sight.  Principles  involved  are  the 
use  of  radio  receivers  which  are  connected 
to  electrodes  in  contact  with  the  visual  cor- 
tex or  to  substitute  the  skin’s  sensory  stim- 
uli for  the  lost  visual  stimuli. 

• Retinoblastoma.  Formerly  malignant 
retinoblastoma  in  children  was  an  indica- 
tion for  early  enucleation.  Now  with  the 
aid  of  newer  technicpies  the  eyeballs  may 
be  retained.  This  is  especially  important 
when  both  eyes  are  involved. 


• Nonmagnetic  foreign  bodies  which 
were  previously  impossible  to  remove  from 
the  eye  are  now  being  extracted  by  using 
low-temperature  techniques.  In  this  new 
procedure  the  tip  of  a low-temperature 
probe  is  placed  in  a position  so  that  it 
comes  in  contact  with  the  foreign  body. 
The  latter  becomes  fused  to  the  cold  tip 
and  is  withdrawn  from  the  eye.  If  vitreous 
is  lost  and  the  eyeball  is  collapsed  follow- 
ing a penetrating  injury,  eye  surgeons  may 
restore  the  fidlness  of  the  eyeball  by  substi- 
tuting a balanced  salt  solution  for  the 
vitreous. 

• Ophthalmologists  as  well  as  most  other 
physicians  have  shown  an  increasing  con- 
cern with  the  problem  of  automotive  medi- 
cine. multidisciplinary  approach  to  the 
jrroblem  has  already  yielded  information 
to  help  reduce  the  physical  damage  and  to 
inqnove  the  treatment  of  patients  involved 
in  automobile  accidents. 

• Angiography.  The  injection  intraven- 
ously of  5%  solution  of  sodium  fluorescein 
is  now  being  used  by  many  ophthalmol- 
ogists. The  fluorescein  dye  aids  in  delineat- 
ing vascidar  abnormalities,  leakage  from 
vessels,  edema  of  the  retina,  abnormalities 
of  the  optic  nerve  disc,  and  in  differentiat- 
ing microaneurysms  from  hemorrhages.  M 

References 

1.  Hubei.  D.  H.  and  ^Viesel.  T.  N,;  “Receptive 
Fields,  Binocular  Interaction  and  Functional 
■Architecture  in  the  Cat's  Visual  Cortex,"  ].  of 
Physiologv  160:106,  1962. 

2.  Bellows,  J.:  “Molekulares  V^orgehen  zinn  Me- 
chanisinus  und  der  Behandlting  der  Herpes- 
virus-Keratitis." Klin.  Monatshl.  fiir  Augeyi- 
lieilkunde  155:696.  1969. 

S.  Fabrykant,  M.,  Gelfand,  M.  and  Carter,  G.: 
"Reversal  of  Hemorrhagic  Diabetic  Retino- 
pathv,"  Annals  of  Ophth.  2:96,  1970. 

4.  AVendland,  J.  P.:  “Retinal  .Arteriosclerosis  in 
.Age.  Essential  Hypertension  and  Diabetes  Mel- 
litus,"  Annals  of  Ophth.  2:68,  1970. 

5.  Radnot,  M.:  “Rheomacrodex  (Dextran)  in  the 
Frcatment  of  the  Occlusion  of  the  Central 
Retinal  Vein,”  Annals  of  Ophth.  1:58,  1969. 

6.  Galin,  M.  et  al:  “Methods  of  Suction  Oph- 
thalniodvnamometry,”  Annals  of  Ophth.  1:439 
1970. 

7.  Hubei  D.  H.  and  Wiesel,  T.  N.:  “Electrophy- 
siology: Period  of  Suseptibility  to  Eve  Closure 
Series  Excerpta  Meclica,”  International  Con- 
gress XXI  Inti.  Congress  of  Ophth.,  p.  E3, 
March,  1970. 


186  to  8 to  ? 

It  took  186  years  from  the  Declaration  of  Independence  until  1962  before  our 
Federal  Government  spent  $100  billion  in  one  year.  But  it  took  only  eight  more 
years  for  the  annual  budget  to  rise  a second  $100  billion,  up  to  $200  billion. 


54 


Illinois  Medical  Journal 


Counter-Measures  Against 
Narcotic  Addiction 

Parents  must  confront  each  of  their  ado- 
lescent children  with  the  dangers  of  taking 
narcotics.  Dr.  D.  W.  Winnicott,  a British 
psychiatrist,  recently  has  stated  that  adults 
are  derelict  in  their  duty  if  they  ignore  or 
lamely  submit  to  the  attitudes  of  the  pres- 
ent generation  of  adolescents.  Confronta- 
tion can  be  a valuable  technique  parents 
need  in  facing  the  tidal  wave  of  drug  addic- 
tion that  threatens  to  innundate  the  pres- 
ent generation.  Confrontation  techniques 
have  been  extensively  studied  by  Dr.  Harry 
Garner,  head  of  psychiatry  at  Chicago  Med- 
ical School.  The  confrontation  technique 
involves  the  use  of  a strong,  positive  ex- 
clamatory sentence  followed  by  a question. - 
An  example  would  be  “I  never  want  you 
to  take  narcotics.”  “What  do  you  think  or 
feel  about  what  I’ve  told  you?”  Hopefully 
this  will  stimulate  the  pre-adolescent  to 
listen  and  to  discuss  the  dangers  of  taking 
drugs  and  maintain  a dialogue  on  the  stdr- 
ject  with  his  parents.  It  is  most  important 
that  the  confrontation  begin  in  pre-adoles- 
cence, before  the  child  has  been  exposed 
to  the  powerful  “peer  group  pressure”  of 
high  school  and  college. 

The  National  Institute  of  Mental  Health 
has  also  been  looking  into  more  effective 
ways  to  change  adolescent  attitudes  toward 
the  use  of  narcotics.^  The  newly  proposed 
program  will  no  longer  emphasize  the  ne- 
gative aspects  such  as  the  dangers  and  side 
effects  of  taking  drugs. 

The  new  approach  is  to  show  teenagers 
the  stupidity  of  taking  drugs  and  the  ex- 
posure of  addicts  to  ridicule.  A spokesman 
for  the  agency  in  charge  of  the  new  cam- 
paign for  NIMH  states  that  as  much  as  he 
dislikes  slogans  they  may  be  effective  in 
modifying  adolescent  attitudes.  He  sug- 
gested, as  a possible  slogan:  ‘AVdiy  do  you 
think  they  call  it  dope?”  To  this  rather 
weak  effort  we  can  add  “Don’t  be  an  ass; 
Keep  off  grass.”  “Don’t  be  duped  by  dope.” 
“Would  you  want  your  appendectomy  done 
by  a speed  taking  surgeon?”  ‘AVould  you 
fly  with  an  airline  pilot  high  on  LSD?” 

Picture  the  following  statement  as  a pos- 
sible poster.  “Don’t  be  duped,  tricked, 
rooked,  badgered,  led,  misled,  forced, 
bribed,  trapped,  lured,  enticed,  enchanted, 
euchered,  talked,  ensnared,  bamboozled, 
coerced,  cajoled,  fooled,  flattered,  deceived. 


hood-winked,  challenged,  harassed,  bluffed, 
coaxed,  shamed,  teased,  tantalized,  manipu- 
lated, bulldozed,  pressured,  persuaded, 
hounded,  pestered,  seduced,  terrorized, 
blackmailed,  threatened,  driven,  pushed,  in- 
veigled, nagged,  cozened,  suckered,  goaded, 
railroaded,  beguiled,  induced,  into  taking 

dope.” 

The  use  of  these  slogans  can  only  be  the 
beginning  of  the  battle  against  the  spread 
of  narcotic  addiction.  A campaign  similar 
to  the  highly  successful  one  the  American 
Cancer  Society  has  developed  is  urgently 
needed.  Local  communities  should  con- 
sider conducting,  with  students  and  civic 
organizations,  an  anti-drug  abuse  day. 

The  medical  profession  should  join  with 
government  agencies,  private  foundations, 
large  corporations  and  the  communications 
media  in  launching  a coordinated  counter- 
attack against  the  insidious  spread  of  drug 
addiction  in  the  LInited  States. 

Harvey  Kravitz,  M.D. 

References 

1.  ^VinnicoU.  D.  \V..  “.Adolescent  Process  and  the 
Need  for  Personal  Confrontation.”  Pediatrics 
4:752,  1969. 

2.  Garner.  H.  H.,  “The  Confrontation  Problem 
Solving  Technique:  Developing  a Psycho-Thera- 
petitic  Force.”  American  Journal  of  Psycho- 
therapy 24:27.  1970. 

3.  Sanford,  D.,  “Unselling  Drugs,”  New  Republic. 
February  28,  1970,  p.  15. 

Pulmonary  Function  Evaluation 

Many  tests  are  available  for  evaluating 
pulmonary  function.  The  majority  of  these 
procedures  are  sophisticated  and  best  per- 
formed by  physicians  specially  trained  in 
pulmonary  physiology.  In  recent  years,  the 
demand  for  these  tests  has  increased  due  to 


for  July,  1970 


the  hish  incidence  of  chronic  bronchitis  and 
emphysema.  Cigarette  smokers  with  a chron- 
ic cough  or  dyspnea  shonid  have  pulmon- 
ary function  studies  made  as  part  of  their 
total  health  evaluation.  The  procedures 
may  provide  the  dehnite  objective  evidence 
that  will  encourage  the  smoker  to  quit. 

How  much  pidmonary  function  equip- 
ment should  the  clinician  buy  for  his  of- 
fice? For  those  who  are  not  specialists  in 
chest  diseases,  a spirometer  is  the  only  piece 
of  equipment  that  is  needed.  The  patient 
shoidd  be  referred  to  the  pidmonary  labora- 
tory if  more  extensive  tests  are  needed. 
Many  types  of  spirometers  are  available; 
the  quality  is  in  proportion  to  the  cost. 
The  most  satisfactory  are  sturdily  construct- 
ed, have  a low  apparatus  resistance,  and 
are  convenient  to  use.  The  paper  speed 
should  be  sufficient  to  make  accurate  mea- 
surements. 

Spirometry  determines  restrictive  and  ob- 
structive types  of  ventilatory  insufficiency. 
The  restrictive  type  is  due  to  loss  of  ventil- 
able  lung  tissue  resulting  from  inflamma- 
tion or  fibrosis.  Loss  of  lung  parencliyma 
may  also  stem  from  destruction  or  resec- 
tion of  lung  tissue,  heart  failure,  or  chest 
wall  disease.  Parenchymal  changes  also  oc- 
cur in  emphysema  and  parallel  the  loss  of 


elastic  recoil  of  the  lungs  as  the  destructive 
process  progresses.  The  vital  capacity  is 
measured  by  having  the  patient  inhale  as 
deeply  as  possible  and  exhale  slowly  into 
the  machine  until  there  is  no  further  flow. 
This  value  is  compared  to  that  of  normal 
individuals  of  the  same  age  and  height. 

Obstructive  ventilatory  insufficiency  usu- 
ally results  from  asthma,  bronchitis,  or  em- 
physema. There  is  an  increase  in  the  resist- 
ance to  air  flow  within  the  bronchial  tree. 
The  forced  vital  capacity  (FVC)  is  obtained 
by  exhaling  rapidly  and  forcibly  to  the 
point  of  no  flow.  Many  measurements  can 
be  obtained  from  this  curve  which  are  then 
compared  to  predicted  values.  Maximum 
voluntary  ventilation  (MW)  can  also  be 
obtained  by  having  the  patient  breathe  as 
vigorously  and  rapidly  as  possible  for  15 
seconds.  In  this  way  the  volume  exhaled 
during  three  or  more  breaths  is  recorded. 
This  is  checked  against  known  standards. 

The  spirometer  is  not  infallible  and  the 
results  should  always  be  correlated  with 
clinical  findings.  This  is  understandable  be- 
cause the  results  are  influenced  by  the  pa- 
tient’s volitional  efforts.  All  of  these  factors 
must  be  considered  to  avoid  overdiagnosis 

O 

of  respiratory  diseases. 

T.  R.  Van  Dellen,  M.D. 


Search  for  Metabolic  Lesion 

The  exact  metabolic  lesion  in  cystic  fibrosis  has  not  yet  been  discovered. 
Approximately  one  of  every  2,000  persons  born  in  the  United  States  is 
afflicted  with  this  generalized  disorder  of  exocrine  glands,  characterized 
by  excessive  mucus  production  and  inability  of  the  ducts  of  sweat  glands 
to  reabsorb  sodium,  chloride  and  potassium.  Chronic  pulmonary  disease 
is  responsible  for  most  of  the  morbidity  and  mortality.  A few  of  the  pa- 
tients succumb  to  abdominal  complications— in  some  cases  as  neonates 
with  meconium  ileus,  in  others  later  in  life  as  a result  of  intestinal  ob- 
struction or  secondary  to  a characteristic;  biliary  cirrhosis.  Attempts  to  ex- 
plain these  striking  and  devastating  clinical  features  have  recently  led  to 
significant  advances  in  knowledge,  providing  clues  for  the  search  for  the 
metabolic  defect  in  cystic  fibrosis.  (Richard  C.  Talamo,  M.D.,  "Cystic  Fibrosis 
of  the  Pancreas— New  Clues  to  the  Metabolic  Riddle."  California  Medici.ie 
n0:5  [May]  1969.) 


Suggestions  Offered 

Is  the  quality  of  service  in  your  hospital,  the  efficiency  of  operation,  and 
the  well-being  of  patients  less  than  desirable?  Are  there  too  many  indif- 
ferent employees?  This  administrator  offers  some  suggestions  for  a pro- 
gram to  eliminate  these  and  other  problems.  (Clyde  T.  Hardy,  Jr.:  "A  Staff 
Meeting  I Would  Like  to  Attend."  Physician's  Management  [June]  1969.) 


56 


Illinois  Medical  Journal 


illinois  state  medical  society 
may  17-20,1970 
Sherman  house, Chicago 


Highlights  of  Convention 
Elections 

Actions  of  House  Delegates 


1970-1971  OFFICERS  AND 
BOARD  OF  TRUSTEES 


Officers 

President 
President-elect 
1st  Vice-President 
2nd  Vice-President 
Secretary-Treasurer 


J.  Ernest  Breed,  55  E.  Washington  St.,  Chicago  60602 
L.  T.  Emin,  5 Citizen’s  Square,  Normal  61761 
George  Shropshear,  1525  E.  53rd  St.,  Chicago  60615 
C.  J.  Jannings  III,  101  E.  Center  St.,  Fairfield  62837 
Jacob  E.  Reisch,  1129  S.  2nd  St.,  Sjjringfield  62704 


House  of  Delegates 

Speaker  of  the  House  Paid  W.  Sunderland,  214  N.  Sangamon  St.,  Gibson  City  60936 
Vice-Speaker  Andrew  J.  Brislen,  6060  S.  Drexel  Blvd.,  Chicago  60637 


Trustees 


1st  District  1971 

2nd  District  1971 

3rd  District  1971 

1971 

1972 

1972 

1973 
1973 


1th 

District 

1973 

5th 

District 

1973 

6th 

District 

1972 

7th 

District 

1973 

8th 

District 

1973 

9th 

District 

1972 

10  th 

District 

1972 

11th 

District 

1971 

Joseph  L.  Bordenave,  1665  South  St.,  Geneva  60134 
VVhn.  A.  McNichols,  Jr.,  101  W.  1st  St.,  Dixon  61021 


William  M.  Lees,  6518  N.  Nokomis,  Lincolnwood  60646 
Frank  J.  Jirka,  Jr.,  1507  Keystone  Ave.,  River  Forest  60305 
Warren  W.  Young,  10816  Parnell  Ave.,  Chicago  60628 
Eredric  D.  Lake,  1041  Michigan  Ave.,  Evanston  60202 
James  B.  Hartney,  410  Lake  St.,  Oak  Park  60302 
Frederick  E.  \\A4ss,  15643  Lincoln,  Harvey  60426 


Fred  Z.  White,  723  N.  Second  St.,  Chillicothe  61523 
A.  Edward  Livingston,  219  N.  Main,  Bloomington  61701 


Mather  Pfeillenherger,  State  & Wall  Sts.,  Alton  62002 
Arthur  E.  Goodyear,  142  E.  Prairie  St.,  Decatur  62523 
Eugene  P.  Johnson,  22  W.  Main  St.,  Casey  62420 


Charles  K.  Wells,  117  N.  10th  St.,  Mt.  Vernon  62864 
Willard  C.  Scrivner,  4601  State  St.,  E.  St.  Louis  62205 
Joseph  R.  O’Donnell,  444  Park,  Glen  Ellyn  60137 


T rustee-at-Large 


Edward  W.  Cannady,  4601  State  St.,  E.  St.  Louis  62205 


Chairman  of  the  Board  Willard  C.  Scrivner,  4601  State  St.,  E.  St.  Louis  62205 


58 


Illinois  Medical  Journal 


CONVENTION  HIGHLIGHTS 


Addressing  the  House  of  Delegates  was  Dr. 
Edwanl  W.  Cannady,  ISMS  president. 

ATTENDANCE  TOTALS 

Attendance  at  the  130th  Annual  Meeting  was  as  follows: 


Physicians 

1.516 

Guests 

256 

Auxiliary 

242 

Exhibitors 

347 

Medical  Students 

76 

Allied  Health  Personnel 

260 

Total 

2,697 

AD  HOC  REFERENCE  COMMITTEE  ADDED 

A new  and  special  reference  committee  was  added  this 
year  to  enable  medical  students  to  express  their  views 
and  opinions. 

MEMORIAL  SERVICE  HELD 

Jacob  E.  Reisch,  M.D.,  ISMS  secretary-treasurer,  con- 
tlucted  a brief  memorial  service  for  the  172  deceased 
ISMS  members.  For  the  first  time  this  past  year  personal 
notes  of  condolence  were  sent  to  families  of  deceased 
members  from  ISMS. 

SAMA  OPINIONS  EXPRESSED 

Lee  Fischer,  medical  student  and  SAM,\  Midwest  Re- 
gional Vice-President,  the  University  of  Illinois,  addressed 
the  House  and  reviewed  S.\M,\’s  involvement  on  the 
medical  scene.  Mr.  Fischer  expressed  the  concern  S.-\M.\ 
members  feel  over  the  relevancy  of  such  projects  as  MECO 
and  better  health  care,  compared  to  the  ellort  spent  on 
the  war.  In  directing  his  remarks  to  the  House,  Mr. 
Fischer  asked  that  students  not  be  ignored  if  they  are 
to  work  together  with  members  of  ISMS  in  solving  prob- 
lems of  health  care  for  all  the  people. 

IMAA  PRESIDENT  REPORTS  TO  THE  HOUSE 

Miss  Ina  Yenerich,  president  of  the  Illinois  Medical 
Assistants  Association,  reviewed  the  past  year’s  activities 
and  cited  the  increase  in  membership  dtie  to  the  work- 
shops sponsored  in  conjunction  with  the  President  s Totir. 
.She  condtided  her  remarks  in  noting  that  the  patients 
will  benefit  most  from  close  coordination  between  doctors 
and  medical  assistants. 


MRS.  ARNOLD  REVIEWS  AUXILIARY'S  PROGRESS 

Mrs.  Sherman  Arnold,  president  of  the  Woman's  ,\tixi- 
liary  to  the  ISMS,  cited  the  primary  objective  of  the 
Auxiliary  as  supporting  the  ISMS  program.  .Atixiliary 
participation  in  the  President’s  Tour  was  the  highlight 
of  the  past  year.  In  behalf  of  the  3,100  members  of  the 
.Auxiliary,  Mrs.  Arnold  presented  to  Dr.  Cannady,  a 
check  in  the  amount  of  ,|7, 934.09  for  Benevolence. 

DR.  THOMSEN  GIVES  IMPAC  REPORT 

Dr.  Philip  Thomsen  urged  members  of  the  House  to 
identify  and  offer  solutions  to  the  social,  economic  and 
medical  proltlems  Itesetting  doctors  before  they  lead  to 
government  intervention.  Physicians  should  cooperate  with 
the  government  in  providing  medical  leadership.  They 
shoidd  also  particijrate  in  political  campaigns  through 
financial  contributions  and  campaign  manpow'er. 

He  discussed  IMPAC's  ellectiveness  and  tirged  more  doc- 
tors to  join  IMP.AC,  especially  from  Cook  Cotnity  where 
the  participation  is  less  than  from  other  cotinties.  He 
noted  that  of  the  369  legislative  bills  presented  in  Illinois 
this  past  year,  90  were  Itills  directly  affecting  physicians 
and  medicine,  which  once  again  emphasized  IMPAC's 
necessity  on  the  legislative  scene. 

ISMS  PRESIDENT'S  REPORT 

Dr.  Edward  Cannady  commented  on  his  role  as  chief 
spokesman  of  I.SMS  on  problems  stich  as  rising  costs  of 
health  care,  training  and  keeping  more  doctors  in  Illinois, 
and  alleviating  the  doctor  shortage  by  sponsoring  and 
stipporting  legislation  establishing  a Department  of  Fam- 
ily Medicine  at  the  I’niversity  of  Illinois.  He  also  cited 
ISMS’s  role  in  sectning  a state  appropriation  for  medical 
school  expansions,  including  |6  million  to  the  Chicago 
Medical  .School  which  will  dotible  the  school’s  enroll- 
ment. The  Society  also  stipported  creating  a medical 
school  for  Sotithern  Illinois  University  and  other  schools 
in  the  downstate  area. 

Dr.  Cannadv  urged  physicians  to  vote  in  favor  of  an 
independent  Council  on  Contintiing  Medical  Editcation 
and  called  for  support  of  the  medical  profession  in  other 
programs  to  provide  effective  and  economical  health  care. 


Dr.  Philip  Thomsen,  chairman  of  the  IMPAC 
Board,  addresses  his  remarks  to  the  delegates 
at  the  first  session  of  the  House. 


for  July,  1970 


59 


Dr.  Leon  O.  Jacobson,  dean,  Pritzker  School 
of  Medicine,  The  University  of  Chicago,  ac- 
cepts a check  on  behalf  of  Illinois’  five  medical 
schools  from  President  Edward  W.  Cannady. 
The  check,  in  excess  of  $120,000,  was  con- 
tributed by  ISMS  members  as  designated  AMA- 
ERF  dues. 

DR.  CANNADY  PRESENTS  AMA-ERF  FUNDS 

Approximately  $120,000  representing  the  total  AMA- 
ERF  collection  for  Illinois  Medical  Schools  was  presented 
to  Dr.  Leon  Jacobson,  dean,  Division  of  Biological  Sci- 
ences, Pritzker  School  of  Medicine,  University  of  Chicago, 
for  distribution. 

EDMUND  F.  FOLEY  ACCEPTS  HAMILTON  TEACHING  AWARD 

Dr,  Edmund  F.  Foley,  emeritus  professor  of  medicine, 
Fhiiversity  of  Illinois  College  of  Medicine,  received 
the  Hamilton  Teaching  Award  for  his  outstanding  quali- 
ties as  a teacher  of  medical  students.  A plaque  and  $500 
cash  award  was  presented  to  him  by  Dr.  George  B.  Calla- 
han, a member  of  the  Board  of  Trustees  of  the  Inter- 
state Postgraduate  Medical  Association. 


Mrs.  Sherman  Ar- 
nold, president,  the 
Woman’s  Auxiliary  to 
ISMS,  speaks  to  the 
House  of  Delegates  at 
the  ISMS  annual  meet- 
ing. 


DR.  MORRIS  FISHBEIN  ADDRESSES  50  YEAR  CLUB  LUNCHEON 

Dr.  Morris  Fishbein,  w'orld-famous  author  and  former 
editor  of  JAMA  compared  today’s  medical  students  with 
those  of  his  day,  noting  the  striking  similarities.  In  ad- 
dition, 39  new  members  were  initiated  into  the  club  and 
presented  with  awards  by  Dr.  Edward  W.  Cannady. 

J.  ERNEST  BREED  INDUCTED  AS  PRESIDENT 

Dr.  J.  Ernest  Breed  was  inducted  as  president  of  the 
ISM.S  at  the  third  House  of  Delegate’s  session.  Administer- 
ing the  oath  of  office  was  outgoing  president.  Dr.  Edward 
W.  Cannady. 

Afterward,  Dr.  Breed  presented  his  inaugural  speech 
emphasizing: 

Immunization  programs  for  needy  pre-school 
children; 

Group  practice  in  rural  areas; 

Peer  Review; 

Malpractice  and 

Continuing  medical  education. 

In  summation  Dr.  Breed  said,  “My  aspiration  for  the 
year  ahead  revolves  around  'how  can  we  make  things 
happen?’— not  ‘what  is  happening  to  us’?’’ 


POLITICAL  SATIRIST  ADDRESSES  PUBLIC  AFFAIRS  DINNER 

Art  Buchwald,  satirist  and  newspaper  columnist,  de- 
livering the  Camp  Memorial  lecture,  delighted  those  in 
attendance  at  the  Seventh  Annual  Public  Affairs  Dinner 
in  speaking  on  “The  Establishment  Is  Alive  and  Well  and 
Living  in  Washington,”  U.  S.  Senator  Ralph  T.  Smith  was 
also  present  at  the  dinner  and  spoke  briefly  on  current 
problems  being  contemplated  by  the  U.S.  Congress. 

PRESIDENT'S  BANQUET  A HIGHLIGHT  OF  CONVENTION 

The  premier  social  event  of  the  convention— the  Presi- 
dent’s Reception  and  Banquet— was  held  on  Tuesday 
evening,  honoring  Dr.  Edward  W.  Cannady  for  a highly 
successful  year  as  ISMS  president.  Entertainment  was  pro- 
vided by  the  Frankie  Masters  Orchestra  and  songstress 
Grace  Markay. 


The  Hamilton  Teaching  Award  was  presented 
to  Dr.  Edmund  F.  Foley,  (right)  professor 
emeritus  of  medicine,  from  the  University  of 
Illinois  College  of  Medicine,  by  Dr.  George  B. 
Callahan,  trustee  of  the  Interstate  Postgraduate 
Medical  Education  Association. 


COUNTY  MEDICAL  SOCIETIES  RECOGNIZED 
FOR  IMMUNIZATION  PROGRAMS 

Dr.  P'ranklin  D.  Yoder,  director,  Illinois  Department 
of  Public  Health,  commended  the  trustees  for  their  sup- 
port in  developing  immunization  programs.  Special  em- 
phasis has  been  placed  on  vaccinating  susceptible  indi- 
viduals such  as  pregnant  women  as  well  as  children  in 
kindergarten  through  third  grade.  He  commended  the 
manv  county  societies  which  have  conducted  immuniza- 
tion programs. 

AMA  PRESIDENT-ELECT  COMMENTS  ON  AMA  SCENE 

Dr.  Walter  C.  Bornemeier  announced  that  two,  30 
minute  documentaries  are  being  produced  by  the  AMA 


Dr.  Edward  W.  Cannady,  past-president  from 
East  St.  Louis,  pauses  to  admire  the  President’s 
Medallion  he  has  just  presented  Dr.  J.  Ernest 
Breed,  at  the  closing  session  of  the  ISMS  an- 
nual meeting. 


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Illinois  Medical  Journal 


Feted  at  the  Annual  Past  Presidents’  Dinner,  for  34  years  with  ISMS,  was  Mrs. 
Frances  C.  Zimmer,  executive  assistant.  (Standing  from  left),  Drs.  Arkell  M. 
Vaughn,  Caesar  Portes,  Edwin  S.  Hamilton,  Edward  A.  Piszczek,  George  F.  Lull, 
Harlan  English,  Philip  G.  Thomsen,  H.  Close  Hesseltine,  Newton  DuPuy,  Jacob 
E.  Reisch  (host).  Seated,  Dr.  Everett  P.  Coleman,  Mrs.  Zimmer,  Dr.  James  H. 
Hutton. 


to  counteract  the  biased  programs  on  health  care  pre- 
sented by  the  CBS  network. 

He  forecast  the  partial  alleviation  of  the  doctor  short- 
age with  the  opening  of  new  medical  schools  and  called 
attention  to  current  residency  programs  which  do  not 
prepare  physicians  to  care  for  the  sick  outside  of  hospitals. 

SCIENTIFIC  EXHIBIT  AWARDS  PRESENTED  TO  EXHIBITORS 

Gol*.  Award— The  Anatomic  Basis  of  Groin 
Hernia  Repair, 

Robert  E.  Condon,  M.D.,  Depart- 
ment of  Surgery,  University  of 
Illinois,  College  of  Medicine. 
Silver  Award— A Demonstration  of  Normal  Tem- 
poral Bone  Anatomy  and  the  His- 
topathology  of  Common  Inner  Ear 
Disorders. 

John  R.  Lindsay,  M.D., 

Horst  R.  Konrad,  M.D., 
Midwestern  Temporal  Bone  Banks 
Center. 

Bronz  Award— Subtraction  Technicjue  with  Color 
Addition. 

A.  K.  Bonk,  M.D. 

Edgewater  Hospital 


1st  Vice  President 
2nd  Vice  President 
Sec'y-Treas. 

Speaker  of  the  House 
\'ice  Speaker 
Trustees  elected  were: 
3rd  District 
3rd  District 
4th  District 
5th  District 
7th  District 
8th  District 


George  Shro]5shear,  Chicago 
C.  J.  Jannings  III,  Fairfield 
Jacob  E.  Reisch,  Springfield 
Paul  ^V.  Sunderland,  Gibson  City 
.Andrew  J.  Brislen,  Chicago 

James  B.  Hartney,  Oak  Park 
Frederick  E.  W'eiss,  Chicago 
Fred  Z.  White,  Chillicothe 
A.  Edward  Livingston.  Bloomington 
Arthur  F.  Goodyear,  Decatur 
Eugene  P.  Johnson,  Casey 


AMA  DELEGATES  ELECTED 

Members  of  the  AMA  Delegation  elected  for  two-year 
terms  beginning  January  1,  1971,  were  Maurice  M.  Hoelt- 
gen,  Francis  \V.  A'oung,  H.  Close  Hesseltine,  Carl  E.  Clark 
and  Joseph  R.  Mallorv.  .Alternate  delegates  elected  were 
Theodore  VanDellen.  Fred  .A.  Tworogcr,  Frank  J.  Jirka, 
Jr.,  Joseph  O'Donnell  and  Jack  Gibbs. 

Harold  .A.  Sofield  w'as  elected  to  serve  the  unexpired 
term  of  Walter  C.  Boniemeier  as  delegate,  to  take  office 
immediately.  Alternates  elected  to  hll  unexpired  terms 
were  Boyd  McCracken,  Glen  Tomlinson,  Herschel  L. 
Browns  and  AVilliam  M.  Lees. 


NEW  OFFICERS  ELECTED  FOR  1970-1971 

Fhe  House  of  Delegates  elected  the  following  officers 
and  trustees: 

President  elect  L.  T.  Fruin,  Normal 


Dr.  R.  Kent  Swedlund,  Watseka,  the  first  to 
register  at  the  130th  annual  meeting,  was 
greeted  by  staff  member,  Betty  Lynch. 


The  Gold  Scientific  Award  was  given  to  Dr.  Robert  E. 
Condon,  from  the  Department  of  Surgery,  University  of 
Illinois  College  of  Medicine  for  his  exhibit,  “The  Ana- 
tomic Basis  of  Groin  Hernia  Repair.” 


for  July,  1970 


61 


Art  Buchwalcl,  political  satirist  and  columnist  was  the  center  of  attention  after 
his  humorous  presentation  of  “The  Estahlishment  Is  Alive  and  Well  and  Living: 
in  Washington,”  at  the  Seventh  Annual  Public  Affairs  Dinner.  Meeting  the  speaker 
were  (from  left).  Dr.  Paul  Theobold,  Dr.  L.  T.  Fruin,  Art  Buchwald,  Dr.  Theo- 
dore Grevas,  and  Tony  Holloway,  Journalism  Fellowship  recipient. 


STAFF  HONORED 

Janies  Shuvny,  director.  Division  of  Public  Relations 
and  Economics,  received  a placjue  in  recognition  of  initia- 
tive, originality  and  outstanding  achievement  in  pidilic 
relations  programming. 

Mrs.  Frances  C.  /iminer  also  was  honored  with  a phupie 
in  recognition  of  her  34  years  of  service  to  I,S\fS, 

HOUSE  TACKS  $2  ON  DUES 

The  House  accepted  the  recommendation  of  the  Board 
of  Trustees  that  the  1970  dues  remain  unchanged  at  .S105. 
However,  upon  recommendation  of  the  Reference  Com- 
mittee on  Education  &:  C-ommunitv  Health  .Services,  the 
House  approved  a special  one-year  assessment  of  .‘52  to 


cover  the  production  and  mailing  cost  of  sending  the 
lUinnis  Medical  ]ournal  and  Pulse  to  all  SAMA  members 
attending  Illinois  Medical  Schools. 


REFERENCE  COMMITTEE  CHAIRMEN 


Constitution  & Bylaws 
O.'licers  it  ,\dmin;stration 
Finances.  Budgets  & 
Publications 

Legislation  & Public  .Affairs 
Education  It  Community  Hi 


Glen  E.  Tomlinson,  Lincoln 
Charles  U.  Culiner.  Waukegan 
Francis  W.  Young,  Chicago 

C'.harles  N.  Salesman,  Robinson 
Lawrence  L.  Hirsch,  Chicago 


Services 

Econoni'cs  it  Social  Services  R.  K.  Swedlund,  Watseka 
Public  Relations  & Misc.  Bus.  Fred  Tworoger,  Chicago 
,\d  Hoc  Robert  E.  Heerens,  Rockford 


Fifty  Year  Club  members  gathered  together  for  a group  picture  were  (from 
top  left),  Drs.  Carl  F.  Steiiihoff,  Proctor  C.  Waldo,  Raymond  S.  Shurtleff,  Max 
F.  Fngerman,  Peter  J.  Werner,  Joseph  J.  Litschgi,  Norbert  Pauker,  (bottom, 
from  left)  Arthur  R.  Bogue,  Woodruff  L.  Crawford,  Henry  F.  Heller,  Charles 
A.  Learsy,  Samuel  M.  Feinherg,  Ralph  A.  Reis,  Robert  M.  Graham,  George  F. 
Irwin. 


62 


Illinois  Medical  Journal 


SUMMARY  OF  ACTIONS  OF  THE 
HOUSE  OF  DELEGATES 

I.  REFERENCE  COMMITTEE  ON  OFFICERS  & ADMINISTRATION 


The  reports  of  Officers,  Trustees,  Chairman  of  the 
Board  of  Trustees,  AMA  Delegation,  Executive  Admin- 
istrator, Speaker,  Vice  Speaker,  Auxiliary  President  and 
Advisory  Committee  to  the  Auxiliary  were  received  and 
accepted,  with  commendation  for  outstanding  service  to 
the  Society. 

In  accepting  the  report  of  the  Policy  Committee,  it 
was  suggested  that  the  Board  of  Trustees  review  the 
policy  statement  on  “Hospital  Records  and  Their  ,\vail- 
ahility”  in  light  of  the  current  hospital  procedure  for 
supplying  photocopies  of  records  on  request  of  Medicare 
intermediaries  and  other  third  parties. 

Reports  of  the  Policy  Committee,  the  Committee  on 
Committees,  Committee  to  Study  Osteopathic  Problems 
and  the  Ethical  Relations  Committee  were  also  accepted 
by  the  House. 

IMPLEMENTATION  OF  PHYSICIANS  LIABILITY  PROGRAM 

Resolution  70M-34  was  adopted,  which  provides  for 
the  implementation  of  the  program  developed  by  the 
Physicians  Liability  Evaluating  Committee.  The  ])rogram 
will  involve  a state- wide  program  on  how  to  avoid  mal- 
practice suits  and  assistance  to  physicians  threatened  with 


suits.  The  details  of  the  program  are  subject  to  approval 
by  the  Board  of  Trustees. 

INCREASED  BOARD  REPRESENTATION  & JOINT  MEETINGS 

■■\cting  upon  a special  amended  report,  the  House  ap- 
proved the  following: 

A fifty  percent  increase  in  representation  on  the 
Board  of  Trustees  from  the  3rd  District  and  no 
change  in  the  composition  of  the  House  of 
Delegates. 

That  the  House  of  Delegates  direct  negotiations 
aimed  to  bring  about  prompt  amalgation  of  the 
annual  scientific  meetings  of  the  ISMS  and  of  the 
Chicago  Medical  Society,  and 
That  the  Constitution  & Bvlaws  Committee  be 
instructed  Now  by  the  House  of  Delegates  to 
submit  the  necessary  recommended  changes  to  the 
1971  annual  meeting  of  the  House  of  Delegates. 
Under  tlie  change  in  representation  the  Board 
of  Trustees  will  consist  of  19  elected  trustees 
(presently  16),  four  elected  officers  (with  vote), 
anil  two  vice  presidents  and  one  vice  sjjeaker 
(without  vote). 


II.  REFERENCE  COMMITTEE  ON  FINANCES,  BUDGETS  & PUBLICATIONS 


1 he  House  accepted  reports  sidjmitted  by  the  Educa- 
tional & Scientific  Eoundation,  Publications  Committee, 
Editorial  Board.  Editor  of  the  IMJ>  tlie  annual  audit 
and  the  Treasurer’s  Report.  It  also  approved  the  report 
of  the  Benevolence  Committee  which  included  increased 
payments  to  a majority  of  recipients. 

PROJECTED  1971  BUDGET 

The  House  approved  the  Reference  Committee  recom- 
mendation that  $6.50  per  each  dues  paying  member  be 
deducted  from  the  previous  $8  allocation  to  the  Per- 
manent Reserves  and  be  placed  in  the  General  Operating 
Eund  to  l)alance  the  1971.  projected  budget.  The  House 
approved  distribution  of  the  dues  dollar  for  1971  as 


follows: 

Operating  Eund  $77.50 

Permanent  Reserves  1.50 

AMA-ERE  20.00 

Benevolence  4.00 

HCCI  2.00 


$105,00 

Special  assessment 
Publication,  production 
and  mailing  IMJ 

for  S.AMA  members  2.00 


Total  $107.00 


In  other  specific  action  the  House  of  Delegates: 
Passed  a resolution  authorizing  the  Board  of  Trustees  to 
request  that  all  undesignated  .AM.A-ERF  funds 
from  ISMS  dues  allocation  be  equally  divided 
among  Illinois  medical  schools. 

Rejected  a resolution  requesting  that  the  $8  allocation 
designated  for  the  reserve  fund  be  iliscontinued 
and  instead  be  placed  in  a special  fund  for 
utilization  in  developing  or  implementing  new 
programs  recommended  by  the  House. 

Rejected  a resolution  calling  for  a dues  increase,  of  which 
a certain  amount  would  be  allocated  to  finance 
SAMA  activities  and  to  reimburse  those  county 
medical  societies  with  an  executive  office  and 
staff. 


■Adopted  a revised  resolution  asking  the  .AM.-A  delegates 
to  introduce  a resolution  in  the  ,AM.A  House  of 
Delegates  requesting  that  the  JAMA  return  to 
its  former  policy  of  omitting  advertising  from 
the  editorial  and  scientific  pages  of  the  JAMA. 

Rejected  a resolution  authorizing  that  all  undesignated 
.AM.A-ERF  funds  from  the  ISMS  dues  alloca- 
tion be  awarded  as  a yearly  prize  to  the  medical 
school  which  has  shown  the  greatest  effort  in 
increasing  the  number  of  Illinois  physicians  who 
go  into  private  practice  in  rural  communities 
and  depressed  citv  areas. 


III.  REFERENCE  COMMITTEE 

PEER  REVIEW 

Approval  was  given  to  the  establishment  of  peer  re- 
view under  the  Bylaws.  Each  component  society  shall 
have,  by  appointment  or  election,  a Peer  Review  Com- 
mittee whose  duty  it  shall  be  to  review  all  proper  com- 
plaints and  inquiries  brought  before  it  by  physicians, 
patients,  institutions,  insurance  carriers  or  government 


ON  CONSTITUTION  & BYLAWS 

agencies.  The  district  peer  review  committee  shall  func- 
tion on  behalf  of  any  county  society  which  does  not  es- 
tablish such  a committee  or  elects  not  to  function. 

The  committee  shall  consist  of  a chairman  and  such 
members  representing  both  general  practice  and  various 
specialties  as  each  individual  county  society  shall  deter- 
mine. Reasonable  rules  and  operational  procedure  shall 


for  July,  1970 


63 


be  established  by  the  component  society.  The  State  So- 
ciety committee  will  act  upon  appeals  from  the  decisions 
of  the  county  or  district  committees. 

SAMA  REPRESENTATION 

Ihider  the  new  Bylaws  S.AMA  will  be  entitled  to  one 
delegate  and  one  alternate  delegate  to  serve  in  the  House 
of  Delegates,  with  full  membership  and  voting  privileges. 

AMA  DELEGATES  ON  COUNCILS  OR  COMMITTEE’S 

Favorable  action  was  taken  on  the  resolution  to  permit 
AMA  delegates  to  serve  as  chairmen  or  members  of  any 
council  or  committee.  Voting  members  of  the  Board  of 
Trustees  may  serve  only  as  advisory  members  to  any 
council  or  committee. 

SEATING  OF  DELEGATES 

Of  particular  significance  for  the  1971  annual  meeting 
was  the  adoption  of  change  in  the  principle  of  seating 
alternate  delegates  during  the  House  of  Delegate  sessions. 
If  a seated  delegate  is  replaced  by  an  alternate,  he  may 
not  be  seated  again  for  that  session,  but  he  may  be  seated 
at  subsequent  sessions. 

In  other  actions  taken  the  House: 

Referred  to  the  Board  of  Trustees  a resolution  requesting 
affiliate  status  for  the  Illinois  Chapter  of  the 
.American  College  of  Radiology  and  that  such 

IV.  REFERENCE  COMMITTEE  ON 

The  reports  submitted  liy  the  Council  on  Economics 
and  Governmental  Health  Programs,  Council  on  Social 
and  Medical  Services,  Committee  on  Disaster  Medical  Care 
and  the  Committee  on  Prepayment  Plans  and  Organiza- 
tions were  accepted. 

VISITING  NURSING  SERVICE  UNDER  MEDICARE 

A resolution  calling  for  a better  understanding  by  the 
Blue  Cross  Medicare  fiscal  intermediary  and  Social  Se- 
curity .Administration  relative  to  payment  for  visiting 
nursing  service  was  not  approved.  The  Flouse  felt  that 
this  problem  was  due  to  a breakdown  of  communication 
and  failure  to  comply  with  existing  guidelines  and  offered 
several  constructive  suggestions. 

ILLINOIS  DEPARTMENT  OF  PUBLIC  AID 

The  report  of  the  .Advisory  Committee  to  the  Illinois 
Department  of  Public  .Aid  was  accepted.  The  House  ex- 
]tressed  appreciation  for  information  regarding  its  func- 
tions and  for  its  outline  of  recommendations  made  to  the 
Department. 

Harold  O.  Swank,  director  of  IDP.A,  called  particular 
attention  to: 

(1)  Payment  for  physical  examinations  and  im- 
munizations of  underprivileged  children  in  first, 
fifth  and  ninth  grades. 

(2)  Payment  of  psychiatric  services  outside  of 
mental  hospitals  as  a future  possibility. 

(3)  Extension  of  “medical  only”  eligibility  for 
a limited  time  to  selected  cases  leaving  public 
aid  rolls. 

(4)  Extension  of  family  planning  services. 

The  report  of  the  Sub-Committee  on  Drugs  and  Thera- 
peutics was  also  adopted. 

DIVISION  OF  VOCATIONAL  REHABILITATION 

The  Advisory  Committee  to  the  Department  of  Voca- 


affiliation  entitle  the  chapter  to  representation 
in  the  House  of  Delegates. 

Referred  to  the  Board  for  further  study  a proposed 
change  in  the  Bylaws  which  would  establish  af- 
filiate societies  wdth  voting  representation  in 
the  House. 

Adopted  an  amended  resolution  which  established  the 
policy  that  the  Committee  on  Committees  shall 
function  at  the  request  of  the  Board  rather  than 
annually,  to  review  and  report  on  the  com- 
mittee structure. 

Referred  to  the  Board  of  Trustees  the  proposed  amend- 
ments that  the  House  of  Delegates  be  the  state 
society  forum  to  set  the  philosophy  of  the  So- 
ciety: and 

Referred  to  the  Board  of  Trustees  a resolution  giving  the 
House  of  Delegates  authority  to  direct  the 
Board  of  Trustees  to  spend  funds  for  the  im- 
plementation of  programs. 

•Approved  in  principle  a resolution  to  permit  county 
medical  societies  to  seek  reimbursement  from 
third  party  organizations  for  expenses  incurred 
through  peer  review  activities. 

•Adopted  a resolution  calling  for  ISMS  to  support  the 
principle  that  county  medical  society  peer  re- 
view committees  be  the  first  source  of  appeal 
from  decisions  made  by  hospital  or  other  medi- 
cal facility  review'  committees. 

ECONOMICS  AND  SOCIAL  SERVICES 

tional  Rehabilitation  was  cited  for  its  effects  to  establish 
an  initial  liaison  with  DVR.  The  recommendations  of 
the  1969  House  of  Delegates  calling  for  the  establishment 
of  guidelines  to  determine  eligibility,  and  emphasizing 
referral  to  the  DA'R  program  by  a physician  was  reaf- 
firmed. 

4 he  Reference  Committee  recommended  and  the  House 
of  Delegates  concurred,  in  requesting  an  investigation  to 
determine  the  possibility  of  over-utilization  of  this  pro- 
gram and  tile  qualifications  for  eligibility.  This  matter 
shotdd  lie  stibmitted  to  the  .Advisory  Committee  on  Me- 
dical Costs  and  EUilization  of  Services  created  by  SB  1139, 
Illinois  76th  General  .Assembly. 

AGING 

The  report  submitted  by  the  Committee  on  Aging  was 
accepted.  Qtiestions  concerning  intraveneous  treatments, 
collection  of  blood  specimens  for  tests,  and  death  certifi- 
cation raised  by  the  Committee  on  Aging,  were  referred 
to  the  ISMS  Medical  Legal  Cotindl. 

NURSING  SCHOOL  CElRTIFICATION 
The  recommendation  of  the  Committee  on  Nursing 
that  certification  of  college-level  medical  paramedical  edu- 
cational ctirrictda  be  transferred  from  the  Department  of 
Registration  and  Echtcation  to  the  appropriate  governing 
board,  w'as  approved. 

HEALTH  CAREERS  COUNCIL 

Based  on  the  report  of  the  .Advisory  Committee  to 
Paramedical  Groups  the  House  agreed  that  the  financial 
support  currently  being  given  to  the  Health  Careers 
Council,  be  continued  at  $2  per  dues  paying  member. 

The  recommendation  that  the  physician  liaison  mem- 
ber to  the  Health  Careers  Council  should  be  a member 
of  the  Advisory  Committee  to  Paramedical  Groups  was 
also  accepted. 


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Illinois  Medical  Journal 


HOSPITAL  REIMBURSEMENT 

Resolution  7M-50,  calling  for  Blue  Cross  and  the  De- 
partment of  Public  Aid  to  use  prospective  rate  negotia- 
tion as  the  method  of  hospital  reimbursement,  was 
adopted.  The  substance  of  this  resolution  will  be  sub- 
mitted to  the  House  of  Delegates  of  the  AMA  when 
it  convenes. 

USUAL  AND  CUSTOMARY  FEE  COMMIHEE 

The  report  of  the  Usual  and  Customary  Fee  Committee 
was  adopted,  including  the  request  that  county  medical 
societies  embrace  the  full  range  of  fees  of  all  physicians 
in  the  area  as  delineated  by  the  usual,  customary  and 
reasonable  definitions,  in  lieu  of  fee  schedules  or  coeffi- 
cients applied  to  relative  value  scales. 

In  specific  actions  taken  on  resolutions  reviewed  by 
this  Reference  Committee,  the  House: 

Reaffirmed  the  concept  of  a contractural  relationship  exist- 
ing only  between  the  physician  and  patient, 
the  necessity  for  consultation  paid  for  by  the 
insurance  carrier,  and  the  acceptance  of  physi- 
cians’ fees  which  are  “usual  and  customary,” 
without  implication  of  any  overcharge  as  basic 
policies  of  the  ISMS. 

Rejected  a resolution  calling  for  the  elimination  of  the 
Drug  Manual  prepared  by  the  Sub-Committee 
on  Drugs  and  Therapeutics. 

Rejected  a resolution  seeking  ISMS  endorsement  of  the 
Attending  Physician's  Statement-Health  Insur- 


ance Claim-Group  or  Individual  form  as  the 
only  claim  form  to  be  completed  by  ISMS  phy- 
sicians after  January  1,  1971. 

Adopted,  as  amended,  a resolution  that,  after  January  1, 
1971,  a representative  of  a group,  clinic,  or 
corporation  may  sign  the  Illinois  Department 
of  Public  Aid  claim  form  with  the  attending 
physician’s  name  appearing  on  the  claim  form. 

Adopted,  in  amended  form,  a resolution  that  ISMS  en- 
courage county  medical  societies  to  establish 
medical  review  committees,  including  utiliza- 
tion review  in  long-term  care  institutions. 

Adopted  a resolution  suggesting  liaison  between  medical 
societies  and  hospital  boards  of  directors  by 
recommending  to  the  AMA  House  that  a pub- 
lication such  as  the  American  Medical  News 
be  sent  to  each  hospital  board  member,  and 
that  hospital  staffs  be  encouraged  to  purchase 
individual  subscriptions  for  hospital  board 
members. 

.Adopted  a resolution  calling  for  ISMS,  other  societies  in 
the  Chicago  area,  and  the  AM.A,  to  establish 
and  operate  a facility  in  the  City  of  Chicago 
to  provide  medical  services  to  disadvantaged 
and  minority  groups. 

Rejected  a resolution  calling  for  updating  the  ISMS  “Re- 
lative Value  Study,  ” preferring  to  rely  on  usual, 
customary  and  reasonable  fee  definitions  as  the 
acceptable  method  of  adjudicating  fees. 


V.  REFERENCE  COMMITTEE  ON  PUBLIC  RELATIONS  & MISCELLANEOUS  BUSINESS 


The  report  of  the  Council  on  Public  Relations  and 
Membership  Services,  including  a report  on  the  Physician 
Placement  Service,  was  accepted.  Reports  of  the  Commit- 
tee on  Medicine  and  Religion  and  the  Task  Force  on 
Physician  Shortage  and  Services  to  Medically  Deprived 
Areas,  were  likewise  accepted. 

In  accepting  the  report  of  the  Committee  on  Insurance, 
it  was  noted  that  over  1,100  physicians  are  now  insured 
under  the  professional  liability  insurance  program. 

PUBLIC  RELATIONS  PROGRAMS 

The  House  endorsed  the  Reference  Committee’s  citation 
for  excellence  of  the  public  relations  programs  on  rising 
health  costs  and  the  ISMS  response  to  the  Senate  Finance 
Committee  report  on  Medicare  and  Medicaid.  The  recom- 
mendation that  consideration  be  given  to  increasing  the 
Public  Relations  Division  staff,  if  increased  public  rela- 
tions services  are  required  by  the  membership,  was 
approved. 

A resolution  requesting  that  ISMS  document  cases  in 
Illinois  of  residents  unable  to  obtain  proper  health  care, 
and  then  propose  a solution  for  the  problem,  was  rejected. 

A resolution  criticizing  the  ISMS  public  relations  pro- 
gram for  failure  to  project  the  viewpoint  of  the  private 
practicing  physician  and  a request  for  reorganization  of 
the  public  relations  program  was  also  rejected. 

MEDICARE,  MEDICAID  AUDIT  AND  PUBLICATION  OF  FACTS 

A substitute  resolution  was  adopted  in  lieu  of  two  sep- 
arate resolutions  calling  for  an  audit  of  the  administra- 
tive costs  and  expenditures  under  the  Medicare  and  Medi- 
caid programs  and  a public  information  campaign  ini- 
tiated, based  upon  these  findings.  The  adopted  substitute 
resolution  recognized  that  a distorted  picture  exists  as 
to  the  adequacy  of  health  care  in  the  United  States, 


the  reasons  behind  the  expense  and  short  comings  of 
the  Medicare-Medicaid  programs  and  called  for  ISMS  to 
continue  to  publicize  the  physician’s  share  of  the  health 
care  dollar  received  under  the  Medicare  and  Medicaid 
programs. 

PRIVATE  MEDICAL  CARE  VERSUS  GOVERNMENT  CARE 

A substitute  resolution  was  adopted  to  replace  one 
calling  upon  the  ISMS  to  urge  AMA  to  develop  a pro- 
gram to  promote  the  present  medical  care  system,  includ- 
ing a “Truth  Squad"  to  shadow  HEW  and  to  correct 
improper  and  incorrect  statements  in  the  news  media. 
The  substitute  resolution  expressed  criticism  of  the  AMA 
for  failure  to  convey  the  positive  aspects  of  private  medi- 
cal care  to  the  public,  castigated  those  who  propose  com- 
pulsoi7  national  health  insurance  and  a complete  change 
in  the  system  of  health  care  delivery  and  called  upon  the 
ISMS  to  urge  the  AMA  to  further  amplify  its  efforts  in 
promoting  the  private  practice  of  medicine.  The  program 
to  be  developed  should  be  directed  to  both  the  public 
and  to  physicians. 

In  other  actions,  the  House  of  Delegates: 

Approved  implementation  of  a study  of  the  important 
relationships  between  medicine  and  religion 
and  seminars  to  be  held  in  various  areas  in 
Illinois  during  1970  under  auspices  of  the  ISMS 
Committee  on  Medicine  and  Religion. 

Affirmed  the  right  of  the  public  to  protection  from  un- 
warranted medical  statements  appearing  in  the 
news  media  or  made  by  those  in  government 
who  have  misrepresented  facts  without  concern 
for  the  health  or  welfare  of  human  beings— the 
ISMS  Public  Relations  program  to  inform  the 
people  of  Illinois  of  this  policy— the  delegates 
to  the  AM.A,  to  introduce  this  principle  into 
the  AMA  House  of  Delegates. 


for  July,  1970 


65 


Adopted  a substitute  resolution  approving  the  concept  of 
a National  Academy  of  the  Health  Professions 
—that  the  study  of  the  delivery  and  cost  of 
health  care,  subsequently  followed  by  appro- 
priate planning,  be  the  primary  concern  of  the 
Academy— that  detailed  reports  be  made  to  the 


AMA  House  of  Delegates  at  appropriate  in- 
tervals. 

Rejected  a resolution  which  referred  to  the  Himler  Re- 
port and  pertained  to  the  wasteful  use  of  man- 
power and  the  method  for  electing  directors 
to  the  proposed  National  Academy  of  Health 
Professions. 


VI.  REFERENCE  COMMUTEE  ON  LEGISLATION  & PUBLIC  AFFAIRS 


Reports  of  the  Council  on  Legislation  and  Public  Af- 
fairs, Committee  on  Public  Affairs,  Task  Force  on  Com- 
prehensive Health  Planning,  Eye  Health  Committee,  Im- 
partial Medical  Testimony  Committee,  Laboratory  Serv- 
ices Committee  and  the  Committee  on  Licensure,  were 
accepted. 

The  initial  report  of  the  Medical  Legal  Council  was 
accepted  but  that  portion  of  the  supplementary  report 
dealing  with  limits  on  nurses  services  in  nursing  homes, 
was  referred  back  to  the  Medical  Legal  Council  for  fur- 
ther study  and  clarification. 

PHYSICIAN  LICENSURE 

The  Reference  Committee’s  recommendation  that  the 
major  problem  with  respect  to  licensure  appears  to  be 
a lack  of  communication  between  the  applicants  and  the 
Medical  Examining  Committee,  was  accepted.  Three  of  the 
four  resolutions,  dealing  with  examining  procedures  un- 
der reciprocity  were  referred  to  the  Medical  Legal  Coun- 
cil and  its  Committee  on  Licensure  for  further  study.  An 
additional  resolution  calling  upon  the  ISMS  to  use  its 
resources  in  seeking  to  have  the  Board  of  Medical  Exam- 
iners process  applications  for  medical  licensure  by  reci- 
procity or  endorsement  on  at  least  a monthly  basis  when 
such  applications  are  pending,  was  adopted. 

LICENSING  OF  MENTAL  HOSPITALS 

A resolution  was  adopted  which  calls  for  the  ISMS  to 
seek  changes  in  legislation  or  administrative  regulations 
to  provide  for  licensing  of  mental  health  facilities.  The 
action  calls  for: 

“Those  services  of  the  Illinois  Department  of 
Mental  Health  which  correspond  to  services 
offered  by  private  psychiatric  hospitals,  gen- 
eral hospital  psychiatric  units  and  sheltered 
care  facilities  be  subject  to  the  same  mini- 
mum standards  (sic— as  other  hospitals),  so 
that  appropriate  parts  of  all  health  care  fa- 
cilities in  the  state  can  be  licensed  by  the  De- 
partment of  Public  Health.” 


INCREASED  TUITION  FEES 

An  amended  resolution  was  adopted  regarding  increase 
in  tuition  fees  to  the  University  of  Illinois  students.  The 
substitute  resolution  provides  that  the  ISMS,  through  its 
Division  on  Legislation  and  Public  Affairs  work  during 
the  upcoming  session  of  the  state  legislature  to  lower  the 
tuition  structure  as  recommended  by  the  Governor. 

PUBLIC  AFFAIRS— AMPAC 

The  House  adopted  an  amended  resolution  relative  to 
the  1971  AMA/AMPAC  Workshop  held  in  Washington, 
D.C.  The  amended  resolution  provides  for  the  ISMS  dele- 
gation to  introduce  a resolution  at  the  AMA  House  of 
Delegates  requesting  that  this  meeting  be  changed  to  the 
broad  type  of  public  affairs  conference  conducted  an- 
nually by  the  Chamber  of  Commerce  of  the  United 
States.  It  further  provides  that  the  conference  be  held 
in  the  early  part  of  the  week  to  permit  visitation  with 
senators  and  congressmen  in  Washington,  that  the  pro- 
gram be  attractive  to  the  general  medical  society  mem- 
bership and  that  the  program  be  publicized  in  advance 
of  the  event. 

A resolution  was  adopted  directing  the  ISMS  delegates 
to  the  AM.A  House  of  Delegates  to  submit  a resolution 
requesting  the  formation  of  a council  or  committee  on 
public  affairs  within  the  AMA  structure. 

ACTION  WITHOUT  REFERENCE-COOK  COUNTY  HOSPITAL 

The  House  adopted  a resolution,  without  reference  to 
committee,  recommending  the  creation  of  a Committee 
to  be  composed  of  two  members  appointed  by  the  Gov- 
ernor, two  members  appointed  by  the  Mayor  of  Chicago 
and  a fifth  memiter,  agreeable  to  both,  who  would  serve 
as  chairman,  to  serve  impartially  in  resolving  the  con- 
troversies and  to  seek  avenues  of  agreement  between  the 
Hospital  Governing  Commission  and  the  Cook  County 
Board  of  Commissioners  in  order  that  the  Cook  County 
Hospital  may  remain  in  full  operation. 


AD  HOC  REFERENCE  COMMITTEE 


A special  ad  hoc  reference  committee  was  appointed  to 
hear  medical  student  views  concerning  student  unrest, 
campus  violence,  the  war  in  Indochina  and  the  needs  of 
the  medically  disadvantaged. 

The  House  agreed  with  the  view's  of  the  Reference 
Committee  in  recognizing  the  mood  of  helplessne.ss  that 
enveloped  the  SAMA  at  the  recent  convention  due  to  the 
problems  at  Kent  State,  Jackson,  Mississippi  and  in  Cam- 
bodia; that  our  national  priorities  need  rearrangement 
and  that  physicians  become  involved  and  accept  the  chal- 
lenge to  be  both  healer  and  citizen. 

The  House  also  agreed  with  the  Reference  Committee 
that  the  free  exchange  of  ideas  between  members  of  the 
Society  and  the  students  provided  a refreshing  segment 


of  the  Annual  Meeting,  although  polarity  was  present  on 
some  of  the  issues.  The  House  also  agreed  with  the  recom- 
mendation that  such  an  opportunity  for  student  and  phy- 
sician colleagues  to  have  meaningful  dialogue  of  broad 
issues  of  concern,  be  a regular  feature  of  future  annual 
meetings. 

In  acting  upon  a resolution  submitted  on  behalf  of  the 
students’  viewpoint  on  the  war  in  southeast  Asia,  the 
House  adopted  a substitute  resolution.  The  substitute 
resolution  provided  that  the  “ISMS  exhort  the  adminis- 
tration of  the  United  States  to  continue  with  all  due 
speed  its  present  policy  of  intent  with  respect  to  humani- 
tarian principles.” 


66 


Illinois  Medical  Journal 


VII.  REFERENCE  COMMITTEE  ON  EDUCATION  & COMMUNITY  HEALTH  SERVICES 


The  House  reviewed  and  accepted  the  reports  submit- 
ted hy  the  Council  on  Education  and  Manpower,  the 
Committee  on  Scientific  Assembly,  the  Council  on  En- 
vironmental and  Community  Health,  Advisory  Committee 
to  SAMA,  the  Cotmcil  on  Mental  Health  and  Addiction, 
the  Committee  on  Narcotics  and  the  Committee  on  Al- 
coholism. 

Commtmications  from  the  Director  of  the  Illinois  De- 
partment of  Public  Health  and  the  acting  Director  of 
the  Illinois  Department  of  Mental  Health  were  received 
as  information. 

CONTINUING  EDUCATION 

The  report  of  the  Committee  on  Continuing  Education 
was  accepted  including  two  recommendations: 

“What  Goes  On”  should  be  revived,  if  adecjuate  fi- 
nancing can  be  obtained;  and 
The  Committee  on  Scientific  Assembly  should  insti- 
tute refresher  courses  for  credit  during  the  1971 
annual  meeting. 

Endorsement,  in  principle,  was  given  to  a continuing 
education  program  under  development  by  the  University 
of  Illinois. 

SPEAKERS  BUREAU 

The  House  expressed  its  appreciation  of  Merck,  Sharp 
and  Dohme  for  continued  financial  support  of  the  ISMS 
Scientific  Speakers’  Bureau  which  provides  scientific  pro- 
grams for  county  medical  society  meetings. 

PHYSICIANS'  ASSISTANTS 

The  reports  of  the  new  Committee  on  Allied  Health 
Education  were  approved.  The  House  gave  encourage- 
ment to  the  Committee  to  proceed  with  its  plans  to  de- 
velop new  categories  of  physician  assistants,  including 
the  use  of  discharged  military  corpsmen  and  premedical 
students  unable  to  find  medical  school  openings.  Also  the 
development  of  an  open-ended  educational  system  which 
would  allow  assistants  eventuallv  to  become  physicians. 

The  House  recommended  that  more  practicing  physi- 
cians be  appointed  to  the  Allied  Health  Committee. 

ADMISSION  POLICIES  OF  U OF  I 

The  report  of  the  Student  Loan  Fund  Committee  was 
approved  with  the  recommendation  that  the  llniversity 
of  Illinois  be  asked  to  develop  admission  policies  and 
tutorial  services  that  will  give  the  same  consideration  to 
borderline  scholars  from  medically  deprived  areas  as  it 
is  now  extending  to  students  from  the  inner  city. 

LOANS  TO  OSTEOPATHIC  STUDENTS 

A resolution  was  approved  endorsing  the  action  of  the 
Student  Loan  Fund  Board  to  indtide  osteopathic  stu- 
dents under  the  loan  program. 

LOAN  PROGRAM  FOR  INNER  CITY 

The  House  adopted  a resolution  calling  upon  the  ISMS 
to  appropriate  monies  from  the  Task  Force  on  Physician 
Shortage  and  Services  to  Medically  Deprived  Areas  to  es- 
tablish a loan  program  for  the  inner  city,  similar  to  the 
present  loan  program  for  rural  students. 

SPECIAL  ASSESSMENT 

Bv  special  assessment  of  $2  per  dues  paying  memher 
for  one  year,  the  Illinois  Medical  Journal  and  PULSE 
are  to  be  mailed  to  SAM,\  members  of  Illinois  chapters. 


NOTE:  As  an  assessment,  this  amount  is  not 
deductible  for  income  tax  purposes,  as 
are  dues. 

LIAISON  WITH  RESIDENTS  AND  INTERNS 

The  .Advisorv  Committee  to  SAMA  was  instructed  to 
develop  and  implement  a plan  of  liaison  with  interns  and 
residents  throtigh  house  staff  organization. 

NO  LEGALIZATION  OF  MARIJUANA 

The  House  approved  the  Child  Health  Committee 
recommendation  that  the  ISMS  oppose  any  legislation  to 
legalize  marijuana.  Illinois  physicians  were  encouraged  to 
distribute  drug  abuse  literature  through  their  offices  and 
in  schools  and  be  present  for  discussions,  if  possible,  when 
drtig  abuse  films  are  shown  in  the  community. 

WELFARE  FOOD  ALLOWANCES 

In  approving  the  report  of  the  Nutrition  Committee, 
the  House  adopted  six  recommendations  regarding  the 
IDPA  food  allowances: 

1. The  IDPA  food  allowance  should  be  increased  to 
conform  with  the  USD.\  Low  Cost  Plan. 

2.  Every  effort  should  be  made  to  expand  and  im- 
plement all  supplementary  food  programs  in  Illi- 
nois including  the  food  stamp  program,  the 
school  lunch  program  and  the  supplementary 
foods  program. 

3.  Food  allowances  should  be  adjusted  in  the  fu- 
ture for  increases  in  the  Bureau  of  Labor  Statis- 
tics Price  Index  with  reevaluations  every  3 
months  and  budgeting  increases  fully  commensu- 
rate with  the  increase  in  the  costs  of  living. 

4.  Other  items  of  the  IDPA  budget  should  be  re- 
vised and  repriced  regularly  to  make  them  cur- 
rent and  decrease  pressure  on  the  food  budget. 

5.  Consumer  education  should  be  further  imple- 
mented and  expanded  by  the  most  efficient  media 
or  method  available. 

6.  Clearing  house  for  nutrition  information  should 
be  established  at  a state  level  with  the  respon- 
sibilitv  of  accumulating  and  disseminating  profes- 
sional nutrition  materials  and  data. 

SHORTER  RESIDENCIES 

The  House  endorsed  a resohition  requesting  the  .AMA 
House  to  condemn  Specialty  Boards  for  lengthening  train- 
ing reejuirements  and  thus  removing  additional  physicians 
from  the  practice  of  medicine. 

SCHOOL  HEALTH  EXAMINATIONS 

•A  policy  was  adopted  which  requires  that  the  ISMS  urge 
all  school  districts  to  provide  funds  in  the  btidget  to  em- 
ploy sufficient  doctors  and  other  health  professionals  to 
carry  out  school  health  procedures  as  recjuired  by  law. 

NOTE:  Present  policy  on  examinations  reads  as 
follows: 

.All  physical  examinations  should  be  performed  in 
the  physician’s  office.  No  examinations  should  be 
conducted  on  a group  basis  unless  authorization 
has  been  given  by  the  local  county  medical  society 
in  a single  instance  or  for  a specific  purpose. 

This  general  statement  does  not  applv  to  the 
industrial  or  occupational  health  physician  in  his 
in-patient  activities, 

.An  amended  resohition  was  adopted  providing  that  all 


for  July,  1970 


67 


physical  examinations  of  children  entering  kindergarten, 
lifth  and  ninth  grades  may  be  done  within  one  month  of 
the  child’s  appropriate  birthday,  commensurate  with  the 
corresponding  grade  level.  The  resolution  is  to  be  for- 
tvarded  to  the  State  Superintendent  of  Public  Instruction 
as  the  basis  for  altering  the  Illinois  School  Code. 

PHYSICAL  STANDARDS  FOR  DRIVERS 
.\n  amended  resolution  was  adopted  which  directs  the 
Committee  on  Public  Safety  to  prepare  a compendium  of 
recommended  minimum  physical  standards  for  evaluating 
drivers  of  specific  vehicles,  to  be  submitted  at  the  next 
annual  meeting  for  approval  and  subsequent  publication. 

In  further  action  the  House: 

Approved  the  removal  of  age  restrictions  on  training  pro- 
grams and  employment  in  health  occupations 
under  the  Illinois  State  Radiation  Protection 
Act. 

Put  ISMS  on  record  in  favor  of  state  income  tax  sharing 
directly  with  school  districts,  to  completely 
subsidize  school  lunch  programs. 

Adopted  a recommendation  that  the  Illinois  Health  De- 
])artment  employ  a full  time  constdtant  in  Ob- 
stetrics and  Gynecology. 

Approved  the  recommendation  that  sex  education  be  a 
part  of  the  medical  school  curriculum. 


Rejected  a resolution  suggesting  that  young  physicians, 
as  :m  alternative  to  military  service,  be  allowed 
to  [nactice  in  those  areas  where  physician 
shortages  are  critical  and  that  equal  time,  pay 
and  privileges  be  extended  to  physicians  serv- 
ing in  either  the  armed  forces,  or  in  areas  of 
medical  need. 

Referred  to  the  Allied  Health  Education  Committee  a 
resolution  requesting  ISMS  to  contribute  310,- 
000  for  1970-1971  to  the  Council  for  Bio-Medi- 
cal Careers,  to  develop  more  interest  in  health 
careers  among  inner  city  students. 

.\dopted  an  amended  resolution  asking  ISMS  to  take 
every  appropriate  action  possible  to  assist  in 
preventing  irreversible  health  hazards  due  to 
the  pollution  of  Lake  Michigan. 

■\dopted  as  amended  a resolution  calling  for  ISMS  to  re- 
cpiest  the  Dejtartment  of  HEW  to  delete  a sen- 
tence from  the  oral  contraceptive  package  in- 
sert. which  in  effect  stated  that  all  side  effects 
tvere  to  be  discussed  between  patient  and  doc- 
tor. a policy  deemed  unwise  by  the  House. 
Rejected  a resolution  on  increasing  the  number  of  medi- 
cal students  in  Illinois  on  the  grounds  that  the 
Society’s  program  is  already  working  in  this 
direction. 


ACTIONS  ON  RESOLUTIONS 
1970  HOUSE  OF  DELEGATES 


Number 

Introduced  by: 

70M-1 

Rock  Island  Co. 

70M-2 

Rock  Island  Co. 

70M-3 

DuPage  County 

70M4 

Madison  County 

70M-5 

Madison  County 

70M-6 

Madison  County 

70M-7 

Madison  County 

70M-8 

Madison  County 

70M-9 

Madison  County 

70M-I0 

Board  of  Trustees 

70M-11 

Fredric  Lake 

70M-12 

.Anna  Marcus,  for 
Com.  on  Medicine 
&:  Religion 

70M-13 

Livingston  County 

70M-14 

Livingston  County 

70M-15 

Frank  J.  Jirka,  Jr.,  for 
Board  of  Trustees 

70M-I6 

Frank  J.  Jirka,  Jr.,  for 
Board  of  Trustees 

70M-17 

Kane  County 

70M-18 

LaSalle  County 

70M-19 

Will-Grundy  County 

70M-20 

Will-Grundy  County 

70M-21 

Will-Grundy  County 

Title 

Processing  of  Licensure  by  Reciprocity 
Elimination  of  Reciprocity 
Examinations 

Third  party  carriers  8c  payment  of  fees 
Documentation  of  need  for  health 
care  in  Illinois 

Reorganization  of  PR  Program 
Atidit  of  Medicare/Medicaid  & 

IPAC  (IDPA) 

Promotion  of  present  system  of 
medical  care 

Audit  of  Meclicare/Medicaid  for 
info,  of  the  public 
School  health  examinations 
AMA-ERE  Llnassigned  Funds 
Affiliate  status  for  III.  Chapter 
.American  College  of  Radiology 
Seminars  on  Medicine  &:  Religion 

Elimination  of  Drug  Manual 
Physical  standards  for  drivers 
Ad  Hoc  Status  for  Comm,  on 
Committees 

Permission  for  AMA  delegates  to 
serve  on  Councils  8c  Committees 
Protection  of  the  Public  from 
Unwarranted  medical  statements 
flse  of  Peer  Review  mechanism 
Restriction  of  occupational 
exposure  of  minors 
School  Lunch  programs 
Third  Party  Claim  forms 


Action 

Adopted 

Referred  to  Medical 
Legal  Council 
Adopted 
NOT  adopted 

NOT  adopted 

Considered  with  #8,  Substitute 
Resolution  adopted 
Substitute  resolution  adopted 

Considered  with  #6,  Substitute 
resolution  adopted 
Adopted  as  amended 
Adopted  as  amended 
Referred  to 
Board  of  Trustees 
Adopted  as  amended 

NOT  adopted 
Adopted  as  amended 
Adopted  as  amended 

Adopted 

Substitute  resolution  adopted 

NOT  adopted 
Adopted  as  amended 

Adopted 
NOT  adopted 


G8 


Illinois  Medical  Journal 


Number 

Introduced  by: 

70M-22 

Will-Grundy  County 

70M-23 

Will-Grundy  County 

70M-24 

Will-Grundy  County 

70M-25 

Will-Grundy  County 

70M-26 

Will-Grundy  Gounty 

70M-27 

Will-Grundy  County 

70M-28 

Will-Grundy  County 

70M-29 

W.  Plassman,  for  Com. 
on  Mental  Health 

70M-30 

W.  Plassman,  for  Com. 
on  Mental  Health 

70M-31 

Lake  County 

70M-32 

Lake  County 

70M-33 

E.  W.  Cannady,  for 
AMA  Delegation 

70M-34 

J.  E.  Reisch,  for 
Commission  on 
Physicians’  Liability 

70M-35 

E.  K.  DuVivier 

70M-36 

Jack  Gibbs,  for 
Student  Loan  Comm. 

70M-37 

Jack  Gibbs,  for 
Council  on  Education 

70M-38 

DuPage  County 

70M-39 

DuPage  County 

70M-40 

A.  J.  Faber,  for  Public 
Affairs  Committee 

70M-41 

J.  Ovitz,  for  Public 
Affairs  Committee 

70M-42 

Fulton  County 

70M-43 

Fulton  County 

70M-44 

Alfred  Klinger 

70M-45 

Alfred  Klinger 

70M-46 

4Vinnebago  County 

70M-47 

Allison  Burdick,  for 
Health  Organization 
to  Preserve  Environ. 

70M-48 

Will-Grundy 

70M-49 

Herschel  Browns 

70M-50 

Board  of  Trustees 

70M-51 

Chicago  Medical 
Society 

70M-52 

Robert.  R.  Hartman 

70M-53 

DuPage  County 

70M-54 

E.  Lowenstein,  for  9th 
District,  ISMS 

70M-55 

G.  Tomlinson 

Title 


Residency  training  periods 
Dept,  of  Public  Aid  Claim 
forms— Procedure 
Long  Term  Institutional  care 
111.  Medical  Society  Reserve  Funds 
Powers  of  House  of  Delegates 
under  Constitution  &:  Bylaws 
Powers  of  House  of  Delegates 
under  Constitution  & Bylaws 
Dues  Increase 

Professional  Licensing  Policies 

Licensing  of  State  Mental 
Health  Facilities 
Liaison  with  Hospital  Boards 
Pagination  Policy  of  J.LMA 
Approval  of  National  Academy  of 
the  Health  Professions 
Malpractice 

Distribution  of  AMA-ERF  unassigned 
Funds 

Inclusion  of  Osteopathic  Students 
in  Loan  Fund  Program 
Opposition  to  tuition  increase  at 
University  of  Illinois 
Nursing  Service  relationships 
with  Medicare 

Financial  support  of  County  Society 
Peer  Review  Committees 
AMA/AMPAC  Workshop  in 
Washington 

AMA  Physician’s  Public  Affairs 
Council 

Himler  Report— Manpower  & 
Composition  of  National  Academy 
Himler  Report— Resolution  of  serv. 
in  urban  8c  rural  areas  as  alternative 
to  military  service 

Loan  Program  for  Inner  City  students 
§10,000  contribution  for  Council  on 
Bio-Medical  Careers 
Increased  Frequency  for  Reciprocity 
Examinations 

Pollution  of  Lake  Michigan 

Current  procedural  terminology  8c 

relative  value  study 

Cessation  of  Hostilities  in  S.E.  Asia 

Hospital  Reimbursement 

Med.  Services  for  disadvantaged 

& Minority  Groups 

Oral  Contraceptive  Pkg.  Insert 

Countv  Society  Peer  Review  Comm. 

as  1st  appellate  body 

Increasing  number  of  practicing 

physicians  in  Illinois 

Cook  County  Hospital  Controversy. 


Action 


Adopted 

Adopted  as  amended 

Adopted  as  amended 
NOT  adopted 
Referred  to 
Board  of  Trustees 
Referred  to 
Board  of  Trustees 
NOT  adopted 
Referred  to  Medical- 
Legal  Council 
Ado]Hed 

Adopted 

Adopted  as  amended 
Substitute  resolution  adopted 

Substitute  resolution  adopted 

NOT  adopted 
Adopted 

Adopted  as  amended 
NOT  adopted 
Approved  in  principle 
Adopted  as  amended 
Adopted 
NOT  adopted 
NOT  adopted 

Adopted 

Referred  to  Allied 
Health  Education 
Referred  to  Medical- 
Legal  Council 
Adopted  as  amended 

NOT  adopted 

Substitute  resolution  adopted 
Adopted  as  amended 
Adopted 

Adopted  as  amended 
Adopted 

NOT  adopted 

Adopted  without  referral 


for  July,  1970 


eg 


THE  VIEW  BOX 


By  Leon  Love,  M.D. 

Director,  Department  of  Radiology,  Loyola  University  Hospital 
and  Chairman,  Department  of  Radiology,  Loyola  University 
Stritch  School  of  Medicine 


This  60-year-old  patient  entered  the 
hospital  iollowing  a sudden  occur- 
rence ot  hemiplegia  on  the  lelt  side 
associated  with  sudden  loss  ol  con- 
sciousness and  an  aphasia.  The  pa- 
tient was  studied  arteriographically 
one  week  later  at  which  time  she  was 
showing  evidence  of  recovery.  A left 
carotid  arteriogram  was  done  (Fig. 
lA,  IB,  1C).  What’s  your  diagnosis? 

(.4nsw’er  on  page  92.) 


70 


Illinois  Medical  Journal 


Evaluation  of 


Hypnotic  effect  of  Methaqualone 


Employing  placebo  responder  elimination 


By  Arpad  Almassy,  M.D. /Chicago 


Among  the  problems  associated  with  typi- 
cal double  blind  evaluations  of  hypnotics 
are  the  need  for  large  numbers  of  patients 
and  the  often  reported  lack  of  discrhnina- 
tion  between  doses  of  soporific  drugs  com- 
monly employed  in  clinical  practice  and 
placebo  controls.  Hinton  has  reported  that 
100  mg.  doses  of  butobarbital,  quinalbar- 
bital  and  amyloharbital  were  “in  most  cases 
insufficient  to  produce  a significant  differ- 
ence from  placebo”  in  the  patients  studied. 
Lasagna  has  suggested,  that  “placebo  reac- 
tors” may  mask  real  differences  between 
drugs  by  their  failure  to  discriminate  be- 
tioeen  potent  and  non-potent  drugs. 


Arpad  Almassy,  M.D.,  is  on 
the  attending  staff  at  Chicago 
State  Tuberculosis  Hospital  and 
Roseland  Community  Hospital, 

Chicago,  Illinois.  He  received 
his  M.D.  from  the  University 
of  Cluj  in  Hungary,  and  serv- 
ed his  internship  and  residency 
at  Cluj.  Dr.  Almassy  was  a 
Board-Certified  Internist  in 
Budapest  (1948),  and  received  Illinois  licen- 
sure in  1959.  He  is  a member  of  the  American 
Thoracic  Society. 


Clinical  efficacy  of  methaqualone,  a non- 
barbiturate hypnotic  with  an  extensive  his- 
tory of  clinical  usefulness  in  the  manage- 
ment of  insomnia,  has  been  reported  by 
Parsons  and  Thomson,^  Barcello-  and  Sa- 
jrienza.3  In  each  of  these  studies,  clinical  re- 
sponse to  methaqualone  was  compared  with 
responses  to  a barbiturate  and  a placebo.  Al- 
though in  each  instance  these  investigators 
were  able  to  confirm  the  hypnotic  efficacy 
of  methaqualone,  they  did  not  find  differ- 
ences between  methaqualone  and  barbitu- 
rates which  might  be  anticipated  on  the 
basis  of  prior  uncontrolled  observations, 
Yaginuma,‘‘  Arvers,®  and  Ravina.® 

Since  Lasagna'^  has  indicated  that  respon- 
siveness to  placebo  may  decrease  sensitivity 
of  clinical  studies  and  thus  obscure  real  dif- 
ferences between  drugs,  we  attempted  to  de- 
vise a means  by  which  the  incidence  of 
jrlacebo  reactors  might  be  reduced.®  This 
procedure,  previously  reported,  was  em- 
ployed in  conjunction  with  a clinical  com- 
parison of  methaqualone,*  pentobarbital 
and  placebo  in  patients  suffering  from  in- 
somnia. 

*SOPOR®,  Arnar-Stone  Laboratories,  Inc. 


tor  July,  1970 


73 


Materials  and  Methods 

Forty-eight  male  j^atients,  who  had  been 
hospitalized  for  the  treatment  of  chronic 
respiratory  disorders,  were  selected  for 
study.  The  age  range  was  from  27  to  87 
years.  Debilitated  patients,  as  well  as  those 
with  severe  disorders  of  liver  or  kidney 
function,  were  excluded.  Similarly,  patients 
who  described  only  moderate  difficulty  in 
getting  to  sleep  and  only  occasional  periods 
of  wakeftdness  dtiring  the  night  were  not 
included. 

Only  patients  with  moderate  insomnia 
(sleeplessness  every  night  with  difficulty  in 
getting  to  sleep,  and  two  or  three  periods 
of  wakefulness  every  night)  and  severe  in- 
somnia (defined  as  an  inability  to  obtain 
a satisfactory  night’s  sleep  without  the  use 
of  hypnotics)  were  selected  for  study. 

In  13  patients  the  history  of  insomnia  Ite- 
gan  with  the  date  of  hospitalization.  In  the 
entire  series  the  history  of  insomnia  ranged 
in  duration  from  several  clays  to  several 
years.  Only  15  patients  had  never  received 
hypnotic  medications  in  the  past.  Barbitu- 
rates had  been  most  commonly  employed 
(23  patients). 

During  the  first  phase  (Phase  I)  of  the 
])iesent  study,  in  an  attempt  to  eliminate 
the  placebo  reactors,  all  48  patients  re- 
ceived a placebo  capsule  (SUIds,®  Arnar- 
Stone  Lalioratories),  containing  sucrose  and 
cornstarch,  at  bedtime.  Phase  1 was  not 
double-blind,  and  the  patients  were  told 
that  the  capsules  were  intended  to  help 
them  sleep.  The  placebo  capsule  j^roduced 
a satisfactory  response,  which  was  sustained 
for  a period  of  14  days,  in  13  patients. 
I’hese  patients  were  classified  as  placebo 
reactors  and  drojjped  from  the  study  group. 
Eight  others  were  also  eliminated  from  the 
study,  for  a variety  of  reason.s,  i.e.,  refused 
to  accept  medication,  during  Phase  I.  The 
remaining  27  patients,  who  had  not  shown 
an  adequate  or  persistent  responsiveness  to 
the  placebo  capsule,  were  then  transferred 
to  the  second  phase  (Phase  II)  of  the  study. 

For  the  second,  double-blind,  phase  of 
the  study  all  medications  were  dispensed  as 
compressed  yellow  tablets  containing  150 
mg.  of  methaqualone,  100  mg.  of  pento- 
barbital sodium,  or  inert  ingredients.  The 
assignment  of  patients  was  by  means  of  a 
series  of  random  numbers,  and  medications 
were  dispensed  by  personnel  not  involved 
in  the  evaluation  of  the  response.  Thus, 


neither  the  patient  nor  the  physician  knew 
the  identity  of  the  drug  used  in  a given 
patient.  At  the  conclusion  of  Phase  II,  it 
was  fotincl  that  ten  patients  had  been  re- 
ceiving methat|ualone,  nine  patients  had 
been  on  pentobarbital  sodium,  and  eight 
had  been  receiving  the  placebo  (as  they 
had  dtiring  Phase  I). 

Results 

The  overall  response  to  therapy  was 
evaluated  each  morning  for  each  patient, 
d'he  criteria  included  ease  of  falling  asleeji, 
frec[uency  of  awakening  during  the  night, 
and  the  presence  or  absence  of  “hangover” 
or  other  side  effects.  All  data  were  collected 

Table  1. 

The  Overall  Response  to  Therapy 
No.  of 


Drug 

No.  of 
Patients 

Nights 

Evaluated  Excellent 

Good 

Fair 

Poo 

Phase 

I* 

13 

162 

56 

92 

13 

1 I 

Phase 

II 

Methaqualone 

10 

123 

35 

73 

13 

2, 

Pentobarbital 

9 

96 

26 

36 

14 

20 

Placebo 

8 

78 

12 

37 

22 

7 

* Single-blind 

phase— placebo 

reactors. 

daily  by  the  ward  physician  personally,  and 
correlated  with  the  nurses’  notes.  An  addi- 
tional parameter,  based  on  an  objective 
evaluation  of  the  duration  of  sleep  was  also 
measured,  as  described  below.  This  evalua- 
tion yielded  the  following  results: 

It  shotdd  be  emphasized  that  the  13 
Phase  I patients  were  “placebo  responders” 
who  were  not  subsecjuently  transferred  to 
the  double-blind  second  phase.  The  per- 
centage of  patients  showing  an  excellent 
response  on  methaqualone  and  pentobarbi- 
tal (28%  and  27%  respectively)  was  essen- 
tially identical  and  approximately  twice  as 
great  as  that  on  the  jffacebo  (15%).  A dif- 
ference between  methaqualone  and  pento- 
haibital  became  more  evident  when  the 
percentage  of  excellent  and  good  responses 
were  combined.  Thus,  the  percentage  of 
excellent-good  responses  on  methacpialone 
was  88;  compared  with  65  on  pentobarbital, 
and  62  on  the  placebo.  It  should  also  be 
noted  that  the  percentage  of  poor  responses 
was  greatest  in  patients  receiving  pento- 
barbital. 

In  addition  to  the  cjualitative  assessment 
of  the  response  summarized  above,  an  ob- 
jective semi-quantitative  evaluation  based 
on  the  duration  of  sleep  was  also  performed. 
The  elapsed  time  between  the  onset  of 


74 


Illinois  Medical  Journal 


Average  Adjusted  Sleep  Scores  (Hours) 


Figure  1. 


Phase  I Placebo  Responders | 

Phase  I Placebo  Non-Responders  |||||||| 
Phase  11  Methaqualone 
Phase  11  Pentobarbital 
Phase  II  Placebo 


sleep  and  time  of  awakening  was  adjusted 
by  subtraction  of  the  duration  of  periods 
of  wakefulness  during  the  night.  If  a jjeriod 
of  wakefulness  was  less  than  30  minutes,  or 
if  the  duration  could  not  be  determined, 
30  minutes  was  arbitrarily  subtracted  (Za- 
roslinski,  et  al).® 

During  Phase  1 (in  the  13  placebo  re- 
sponders) the  average  adjusted  sleep  score 
was  6.9  ± 0.15  hours.  In  those  patients 
who  were  not  responsive  to  the  placebo  in 
Phase  I (the  27  patients  subsequently 
transferred  to  Phase  II),  the  average  ad- 
justed sleep  score  was  3.7  ± 0.19  hours. 
During  Phase  II  the  adjusted  sleep  score 
on  methaqualone  was  7.0  ± 0.28  hours;  on 
pentobarbital  it  was  6.2  ± 0.45  hours;  and 
on  the  placebo  it  was  4.8  ± 0.78  hours. 
These  average  adjusted  sleep  scores  may  be 
compared  graphically  as  in  Figure  1. 

The  average  adjusted  sleep  scores  for 
methaqualone,  pentobarbital,  and  placebo 
were  compared  using  Fisher’s  Analysis  of 
Variance  Techniques  (Batson).**  Prelimin- 
ary analysis  of  variance  clearly  established 
that  the  scores  differed  significantly 
(P<0.01).  The  alternate  analysis  of  vari- 
ance test  was  then  enqaloyed  to  determine 
differences  between  the  individual  groups. 
Examination  of  the  residt  data  showed 
that  methaqualone  was  significantly  more 
effective  (P<0.05)  than  both  pentobarbital 
and  placebo. 

The  response  to  methaqualone  was  sig- 
nificantly superior  to  that  induced  by  pen- 
tobarbital or  placebo.  There  were  no 
serious  side  effects  reported  for  any  of  the 
medications  during  the  course  of  this 
study.  Occasional  patients  complained  of 
minor  effects  such  as  drowsiness,  etc.,  but 
were  too  few  in  number  to  permit  a mean- 
ingful statistical  analysis. 


Discussion 

Selection  of  patients  for  a clinical  study 
usually  presents  problems  in  regard  to  the 
suitability  of  particular  subjects.  Ostensibly, 
careful  observation  and  case  history  should 
serve  to  facilitate  such  selection.  However, 
our  results  suggest  that  full  reliance  on 
these  ])rocedures  may  result  in  the  inclu- 
sion of  some  subjects  who  are  not  fully 
suitable  as  clinical  material.  Pre-screening 
with  respect  to  placebo  responsiveness 
would  appear  to  be  worthwhile. 

It  is  of  interest  that  the  response  to 
metluupialone  was  significantly  superior  to 
that  of  pentobarbital  both  qualitatively  and 
(piantitatively.  This  is  in  contrast  to  results 
rejjorted  by  Parsons,'  Barcello,^  and  Sa- 
pienza.®  These  authors  found  no  significant 
difference  between  effects  obtained  with 
metluupialone  and  cyclobarbital,  secobarbi- 
tal, and  pentobarbital,  respectively.  The 
subjective  excellent-good-poor  grading  of 
patient  response  has  been  widely  employed 
by  clinical  investigation  and  may  be  re- 
sponsible for  failure  to  exhibit  differences 
between  hypnotics,  or  hypnotics  and  place- 
bo, in  the  usual  clinical  dosages.  Objective 
data  is  preferable,  and  the  patient’s  response 
should  be  the  valid  goal  of  such  a study. 
We  believe  that  the  addition  of  the  semi- 
quantitative  evaluation  introduced  here  en- 
hances the  validity  of  the  study  and  in- 
creases the  degree  of  discrimination. 

The  preliminary  elimination  of  placebo 
responders,  32.5%  of  the  population,  may 
account  for  this  difference.  The  omission 
of  placebo  responders  appeared  to  make  the 
population  being  tested  more  homogeneous 
and  decrease  extraneous  variables.  Deletion 
of  placebo  responders  appeared  to  increase 
the  sensitivity  of  the  clinical  test  procedure 


for  July,  1970 


75 


by  providing  a more  valid  insomnia  popu- 
lation. Thus,  the  drug  response  is  being 
tested  against  the  specific  complaint  and 
the  hnal  results  are  not  being  diluted  by 
patients  which  normally  respond  to  placebo 
therapy.  However,  insomnia  is  self-limiting 
and  a degree  of  placebo  response  can  occur 
even  after  preliminary  elimination  of  de- 
finite placebo  responders. 

The  importance  of  the  “placebo  reactor” 
in  the  evaluation  of  drugs  has  been  describ- 
ed by  Lasagna,"  Batterman^oii  and  Zaros- 
linski,  et  al.®  Since  there  is  an  important 
psychosomatic  element  in  insomnia,  com- 
parisons of  hypnotic  drugs  should  include 
elements  designed  to  reduce  the  impact  of 
the  placebo  responder  insofar  as  this  is  pos- 
sible. We  believe  that  this  was  largely  ac- 
complished in  the  present  study  by  its  di- 
vision into  phases,  the  first  of  which  was 
solely  designed  to  eliminate  placebo  re- 
sponders. 

Because  of  the  additional  control  ele- 
ment provided  by  the  first  phase  of  our 
study,  it  is  our  opinion  that  the  validity  of 
our  results  is  enhanced  and  a more  accu- 
rate determination  is  possible  with  fewer 
patients.  These  results  indicate  that  a dose 
of  150  mg.,  methaqualone  is  a highly  effec- 
tive hypnotic.  Methaqualone  was  found  to 
produce  a statistically  significant  increase 
in  the  adjusted  average  duration  of  sleep 
when  compared  to  pentobarbital  and  place- 
bo. This  value  of  the  duration  of  sleep  was 
valid  both  qualitatively  and  quantitatively. 

Summary 

Forty-eight  male  patients,  who  had  been 
hospitalized  with  various  chronic  respira- 
tory diseases,  were  selected  for  a double- 
blind, placebo-controlled  evaluation  of 
methacpialone  and  pentobarbital  sodium  in 
the  management  of  insomnia.  The  study 
was  divided  into  two  phases.  During  the 
first  phase,  all  patients  were  given  a pellet- 
containing,  placebo  capsule.  During  this 
phase,  which  was  not  double-blind,  eight 
patients  were  dropped  from  the  study  group 
for  various  reasons.  Twenty-seven  others 
were  taken  off  the  placebo  within  14  days 
because  it  failed  to  induce  a persistently 


adequate  response.  These  patients  subse- 
quently entered  the  second  phase  of  the 
study.  Finally,  there  were  13  patients  who 
responded  consistently  to  the  placebo,  and 
when  this  responsiveness  was  found  to  con- 
tinue for  a period  of  14  days,  they  were 
removed  from  further  consideration  as 
“placebo  reactors.” 

During  the  second  phase  of  the  study, 
ten  patients  received  methaqualone  (150 
mg.  at  bedtime),  nine  were  given  pento- 
barbital sodium  (100  mg.  at  bedtime),  and 
eight  received  the  placebo.  Both  medica- 
tions and  the  placebo  were  in  the  form  of 
compressed,  yellow  tablets,  and  this  phase 
of  the  study  was  double-blind.  In  addition 
to  subjective  observation  recorded  by  train- 
ed medical  observers,  a semi-quantitative 
parameter  of  adjusted  sleep  duration  was 
evaluated. 

The  percentage  of  excellent  and  good  re- 
sponses on  methaqualone  (88)  was  greater 
than  that  on  pentobarbital  (65)  or  placebo 
(62).  The  adjusted  average  duration  of 
sleep  on  methaqualone  (7.0  hours)  was 
greater  than  that  of  pentobarbital  and 
placebo  to  a statistically  significant  degree. 


References 

1.  Parsons,  T.  W.,  and  Thomson,  T,  J.  “Metha- 
qualone as  a Hypnotic,”  Brit.  M.  J.,  1:171-173 
n961). 

2.  Barcello.  R,  “A  Clinical  Study  of  Methaqua- 
lone: A New  Non-Barbiturate  Hypnotic,” 

Canad.  M.  A.  J.,  85:1304-130,5  (1961). 

3.  Sapienza,  P,  L.  “A  Double-Blind  Comparison 
of  Methaqualone,  Pentobarbital  and  Placebo 
in  the  Management  of  Insomnia,”  Cnrr. 
Therap.  Res.,  8:523-527  (1966), 

4.  Yaginuma,  Y,,  Gonoi,  T.  and  Kokubus,  S. 
Brain  Nerve  (Japan),  13,  p.  469  11961). 

5.  Arvers,  J.  J.,  These  Med.,  Paris  (1958). 

6.  Ravina,  A.,  Press.  Med.,  67:891-892  (1959). 

7.  I.asagna,  L.,  Mosteller.  F.,  Von  Felsinger,  J.  M., 
and  Beecher,  H.  K.  “A  Study  of  the  Placebo 
Response,”  Am.  J.  Med.,  16:770-779  (1954). 

8.  Zaroslinski,  J.  F.,  Browne,  R.  K.,  and  Almassy, 
.\.  "Placebo  Response  in  the  Evaluation  of 
Hypnotic  Drugs,”  J.  Clin.  Pharmacol.  (1969). 

9.  Batson,  H.  C.  An  Introduction  to  Statistics 
IN  THE  Medical  Sciences.  Burgess  Publishing 
Co.,  Minneapolis,  Minn.,  22-37  (1961). 

10.  Batterman,  R.  “Persistence  of  Responsiveness 
with  Placebo  Therapy  Following  an  Effective 
Drug  Trial,”  J.  New  Drugs,  6:137-141  (1966). 

11.  Batterman,  R.,  and  Mouratoff,  G.  “Reproduc- 
ibility of  Data:  Test  of  Method  for  Evaluat- 
ing Sedative  and  Analgesic  Medications,” 
Cnrr.  Therap.  Res.,  5:444-449  (1963). 


Little  Facts  About  Big  Government 

The  U.  S.  Department  of  Agriculture  spent  five  years  revising  pickle  standards 
in  order  to  describe  the  difference  between  curved  and  crooked  pickles. 


76 


Illinois  Medical  Journal 


SOCIO  ECONOMIC 

news 


A service  of  the  Public  Relations  and  Economics  Division 


''Foundations  for 
Medical  Care" 
Considered 


Black  Ink  "A  Must" 
On  Vital  Records 


ISMS  Members 
Support  Public 
Health  Programs 


By  Joseph  J.  Lotharius 

ISMS  Trustees  are  seriously  considering  the  pros  and 
cons  of  the  “Foundation  for  Medical  Care”  concept.  FMC’s 
are  presently  active  in  several  California  counties  and  their 
popularity  is  beginning  to  spread  eastward.  An  FMC  is  an 
organization  of  physicians,  sponsored  by  a local  medical 
society,  who  are  concerned  with  the  development  and  de- 
livery of  medical  services  and  the  reasonable  cost  of  health 
care,  rvhether  privately  or  publicly  financed. 

The  FMC  concept  includes  free  choice  of  a personal 
physician,  the  fee  for  service  concept,  and  local  control 
through  peer  review  mechanisms.  FMC’s  can  set  up  mini- 
mum health  care  standards  and  offer  broad  coverage  with- 
in a reasonable  cost  level.  Quality  care  is  emphasized 
through  utilization  review  techniques  by  both  physician 
and  patient.  Is  the  FMC  concept  the  “wave  of  the  future” 
— ancl  the  answer  to  a national  health  insurance  system? 

All  Illinois  physicians,  funeral  directors,  coroners  and 
hospital  administrators  were  urged  to  start  using  black  ink 
when  filling  out  vital  records  which  will  be  reproduced. 
The  request  was  made  by  Dr.  Franklin  D.  Yoder,  director 
of  the  Illinois  Department  of  Public  Health.  Dr.  Yoder 
announced  that  beginning  January  1,  1971,  his  Depart- 
ment would  instruct  local  registrars  and  county  clerks  to 
accept  for  filing  ONLY  those  certificates  filled  out  in  black 
ink.  He  said  in  order  to  insure  clear,  sharp  certified  copies 
from  either  a photocopy  or  from  microfilm,  the  original 
certificate  must  be  prepared  in  clean,  black  typewriter  rib- 
bon or  black  ink. 

A recent  ISAIS  survey  of  county  medical  societies  revealed 
nearly  2,500  physicians  gave  more  than  12,500  free  man- 
hours of  time  worth  an  estimated  .|I660,000  to  public  health 
programs  during  the  past  year.  Over  800,000  children 
benefited  from  free  inoculations  or  screening  programs 
during  the  12-month  period  ending  May  15.  Inoculation 
programs  included  rubella,  measles,  diphtheria,  smallpox 
and  polio.  Screening  projects  included  pre-school  visual 
exams,  hearing  and  vision  tests,  physical  examinations,  tu- 
berculosis and  diabetes  testing.  These  statistics  are  very 
conservative  because  less  than  25  per  cent  of  the  state's 
county  societies  responded  to  the  survey. 


for  July,  1970 


81 


Be  EXACT  On  Your 
Medicare  Claim  Form 


RE:  Third  Parties 
And  Fees 


Physicians  treating  Medicare  patients  should  make  cer- 
tain their  patient’s  name  listed  on  the  1490  claim  form  is 
an  EXACT  duplicate  of  the  name  appearing  on  the  pa- 
tient’s health  insurance  card.  According  to  Continental 
Casualty  Co.,  Part  B Medicare  carrier  for  much  of  Illinois, 
any  difference,  however  slight,  could  delay  your  claim  as 
much  as  90  days.  Continental  reported  that  all  Medicare 
eligibility  records  are  maintained  in  Baltimore  by  the  So- 
cial Security  Administration  and  computerized  techniques 
in  checking  records  require  the  exact  information. 

•I‘**I**I**I"*I'**I**I**I''*l''*I''*I’'*i**I""I"*I""I**I""I* 

ISMS  Delegates  reaffirmed  three  basic  principles  during 
the  convention  regarding  third  party  carriers  and  payment 
of  fees.  These  are:  1)  Unless  a physician  accepts  assignment 
as  payment  in  full,  the  patient,  not  the  third-party,  is  re- 
sponsible for  payment  of  medical  fees;  2)  a patient  should 
be  reimbursed  by  his  insurance  carrier  for  necessary  consul- 
tation fees;  and  3)  a physician’s  usual  and  customary  fees 
should  be  accepted  as  such  by  the  carrier,  with  contractual 
reimbursement  made  to  the  patient,  with  the  carrier 
implying  any  “overcharge.” 


Film  Reviews 


The  nature  of  cystic  fibrosis,  its  genetic 
transmission,  procedures  for  diagnosis  and 
treatment  are  explored  in  “Diagnosis  and 
Management  of  Cystic  Fibrosis,"  a 16mm, 
sound,  color  film.  The  film  refers  to  research 
attempting  to  establish  the  etiology  of  cys- 
tic fibrosis  and  to  pinpoint  the  underlying 
biochemical  defect  v/hich  results  in  the  se- 
cretion of  abnormal  sweat,  saliva,  and 
mucus.  Also  discussed  in  the  film  are  diet, 
exercise,  the  role  of  the  parents  in  home 
care,  surgical  complications  and  child-bear- 
ing by  young  women  affected  with  the  dis- 
ease. Contact  for  free  short-term  loan;  Na- 
tional Medical  Audiovisual  Center  (Annex), 
Station  K,  Atlanta,  Georgia  30324,  Attn: 
Film  Distribution. 

"A  Matter  of  Opportunity,"  a 16mm,  27 
minute  film  explores  the  situations  faced  by 
black  students  as  they  pursue  careers  in  the 
field  of  medicine.  The  need  for  black  phy- 
sicians, black  paramedical  people,  black 
midwives,  and  black  nurses  is  also  dis- 
cussed in  the  film,  available  on  loan  to 
medical  societies  from  the  AMA  Film  Li- 
brary, 535  North  Dearborn  Street,  Chicago 
60610. 


"Intestinal  Amebiasis"  and  "Extraintes- 
tinal  Amebiasis"  are  two  of  the  16mm  films 
in  the  clinical  pathology  series.  Illustrations 
include  drawings  and  photographs  of  the 
parasite,  typical  and  atypical  ulcers,  and 
preparation  of  wet  mounts.  The  aspects  of 
extraintestinal  amebiasis,  including  hepa- 
tic abscess  and  cutaneous  complications  are 
dealt  with  in  the  second  film.  Contact  for 
free  short-term  loan:  National  Medical  Au- 
diovisual Center  (Annex),  Station  K,  At- 
lanta, Georgia  30324. 

"Current  Trends  in  the  Therapy  for  Nar- 
cotic Addiction,"  a 16mm,  29  minute  film 
features  Dr.  Daniel  H.  Casriel,  medical  psy- 
chiatric superintendent  of  Daytop  Village, 
a therapeutic  community  for  addicts,  and 
Dr.  Jerome  H.  Jaffe,  director  of  the  Drug 
Abuse  Program  in  Illinois.  Dr.  Casriel  views 
narcotic  addiction  as  "withdrawal  behind  a 
chemical  as  a response  to  stress."  Dr.  Jaffe 
questions  the  psychiatric  approach  and  dis- 
cusses the  methadone  treatment  of  addicts 
in  Chicago.  Contact:  National  Medical  Au- 
diovisual Center  (Annex),  Station  K,  Atlan- 
ta, Georgia  30324,  for  free,  short-term 
loan. 


8;: 


Illinois  Medical  Journal 


Achrocidin  

Lederle  Laboratories 


Rx  Products 
Index 

25  Neosporin  Ointment  

Burroughs  Wellcome  & Co. 


3 


Achromycin  3rd 

Lederle  Laboratories 

Cover 

Neo-Synephrine  

Winthrop  Laboratories 

4 

Achrostatin  

Lederle  Laboratories 

93 

Flagyl  

G.  D.  Searle  & Co. 

2nd  Cover 

Aventyl  HCL  

Eli  Lilly  and  Company 

...14-15 

Orenzyme/AVC  

National  Drug  Co. 

71,  72 

Coi’dran  Tape  

Eli  Lilly  and  Company 

32 

Plastipak  

Becton,  Dickinson  & Co. 

7,  8 

Dicarbosil 

92 

Salutensin  

Bristol  Laboratories 

12-13 

Arch  Laboratories 

Equanil 

Wyeth  Laboratories 

...9,  10 

Sinequan  

Pfizer  Laboratories  Div., 
Pfizer  Inc. 

27-30 

Garamycin  

Sobering  Corp. 

...77-79 

StomAseptine  

Harcliffe  Laboratories 

21 

Librium 

Roche  Laboratories 

.22-23 

Tepanil/Quinamm  

National  Drug  Co. 

17,  18 

Mylanta  

Stuart  Pharmaceuticals  Div., 
Atlas  Chemical  Industries,  Inc. 

24 

Valium  

Roche  Laboratories 

..Back  Cover 

Use  of  Methadone 

The  potential  motivation  of  criminal  addicts  for  methadone  treatment 
was  tested  in  the  New  York  City  Correctional  Institute  for  Men.  Of  165 
inmates  seen,  all  with  records  of  five  or  more  jail  sentences,  116  (70  per 
cent)  applied  for  treatment  after  a single  interview.  None  of  them  had 
previously  made  application  to  the  methadone  program. 

Of  18  randomly  selected  from  all  applicants  with  release  dates  be- 
tween January  1 and  April  30,  1968,  12  were  started  on  methadone  be- 
fore they  left  jail  and  then  referred  to  the  program  for  aftercare.  None 
of  them  became  readdicted  to  heroin,  and  nine  of  12  had  no  further  con- 
victions during  the  50  weeks  of  follow-up  study.  All  of  an  untreated  con- 
trol group  became  readdicted  after  release  from  jail,  and  15  of  16  were 
convicted  of  new  crimes  during  the  same  follow-up  period.  (Vincent  P. 
Dole,  M.D.,  J.  Waymond  Robinson,  M.D.,  John  Orraca,  Edward  Towns,  Paul 
Search  and  Eric  Caine:  "Methadone  Treatment  of  Randomly  Selected  Crim- 
inal Addicts."  New  England  J.  Med.  280:25  [June  19]  1969.) 


/or  July,  1970 


83 


OCTOR'S  LIBRARY 


Lung  Cancer;  A Study  of  Five  Thou- 
sand Memorial  Hospital  Cases,  Edited 
by  William  L.  Watson,  Published  by  C. 
V.  Mosby  Co.,  St.  Louis,  1968.  454  Ulus., 
inch  6 color  plates,  584  pages.  Price: 
$29.50. 

This  review  of  the  5,000  cases  of  lung 
cancer  seen  at  the  Memorial  Hospital  is 
analyzed  to  present  the  natural  history  of 
the  disease,  its  diagnosis,  treatment,  and 
prognosis.  As  such  it  is  a valuable  contri- 
bution to  our  information  on  cancer  of  the 
lung.  Despite  multiple  authorship,  a uni- 
fied philosophy  relative  to  the  management 
of  patients  with  lung  cancer  is  presented. 
The  trend  is  more  aggiessive  in  all  aspects 
of  therapy  than  is  generally  utilized  by 
many  thoracic  surgeons  at  the  present  time. 
Unique  in  their  experience  is  the  use  of 
interstitial  implantation  of  radioactive  seeds 
at  the  time  of  thoracotomy  when  nonre- 
sectable  disease  is  found.  Sporadic  use  of 
this  form  of  treatment  has  been  used  by 
others  but  the  experience  at  the  Memorial 
Hospital  is  the  most  extensive  in  America. 
Whether  or  not  greater  acceptance  of  the 
modality  by  others  based  on  the  good  re- 
sults reported  cannot  be  answered. 

The  text  is  well  written  and  the  illus- 
trations are  of  high  quality.  Numerous 
chapters,  among  which  are  the  ones  on  the 
radiologic  diagnoses,  pathology,  and  cy- 
tology, are  excellent.  Unfortunately,  in  an 
attempt  to  be  all  inclusive,  pleural  tumors 
and  benign  tumors  of  the  lung  are  also 
covered  in  the  text;  neither,  do  I believe, 
should  come  under  the  heading  of  lung 
cancer.  Likewise,  in  review  of  the  hormonal 
manifestations,  insulin  activity  which  has 
been  associated  with  pleural  tumors  is  dis- 
cussed, which  may  confuse  the  unwary. 

The  text  may  be  recommended  to  all 
those  interested  in  lung  cancer  and  should 
be  a ready  reference  volume. 

Thomas  W.  Shields,  M.D. 


Todd  Sanford  Clinical  Diagnosis  By 
Laboratory  Methods,  Edited  by  Israel 
Davidsohn,  M.D.,  E.A.C.P.  and  John  Ber- 
nard Henry,  M.D.,  1,308  pages,  W.  B. 
Saunders  Company,  1969. 

The  field  of  clinical  pathology  has  now 
gTown  so  large  that  it  is  virtually  impos- 
sible to  compress  it  all  into  one  volume, 
and  it  is  necessary  to  concentrate  on  cer- 
tain topics  of  practical  interest.  In  the  new 
edition  of  this  classic  text,  emphasis  has 
been  placed  on  hematology,  microbacteri- 
ology and  clinical  chemistry.  The  text  has 
been  completely  rewritten  by  many  new 
contributors.  New  chapters  on  spectropho- 
tometry, endocrine  measurements,  amniotic 
fluid,  pregnancy  tests,  seminal  fluid,  cyto- 
genetics and  laboratory  planning  serve  to 
round  out  the  text  and  are  successful  in 
bringing  it  up  to  date. 

The  book  is  increased  in  size  by  288 
pages,  and  in  weight  by  873  grams,  to  a 
total  weight  of  over  3.2  kilograms.  This  is 
large  enough  that  it  is  uncomfortable  for 
bedtime  reading.  Perhaps  the  editors  will 
consider  printing  the  next  edition  in  two 
volumes. 

This  standard  text  book  is  recommended 
for  physicians  interested  in  clinical  labora- 
tory diagnosis,  medical  students  and  medi- 
cal technologists.  It  is  a necessary  reference 
book  for  the  practicing  pathologist. 

Joseph  C.  Sherrick,  M.D. 

Prematurity  and  the  Obstetrician  Denis 
Cavanagh  and  M.  R.  Talisman,  Apple- 
ton-Century-Crofts,  New  York,  New  York 
April,  1969. 

This  unique  and  well-written  book  deals 
with  premature  infants  from  the  obstetric 
point  of  view,  discussing  not  only  the  prob- 
lems but  also  the  treatment  and  prevention 
of  prematurity.  The  view  given  by  the 
authors  is  comprehensive,  and  the  team  ap- 


84 


Illinois  Medical  Journal 


proach  is  emphasized  as  necessary  in  de- 
creasing premature  mortality.  Improved 
antepartum  care  is  stressed.  The  book  is 
very  practical,  emphasizing  the  clinical  as- 
pects of  the  problem.  Most  of  the  book 
is  written  by  Cavanagh  and  Talisman,  but 
there  are  special  sections  written  by  eight 
contributors  which  add  to  the  whole. 

The  chapters  are  well-organized,  clearly 
written,  and  understandable.  Charts  and 
graphs  are  used  where  necessary  and  are 
relevant  to  the  material  being  demonstrat- 
ed. A substantial  list  of  references  follows 
each  chapter.  The  chapters  covering  ma- 
ternal and  fetal  factors  in  premature  labor 
are  good,  including  maternal  diet,  infec- 
tions, medications,  and  anomalies  as  well 
as  isoimmunization.  Surgical  procedures  in 


pregnancy  are  discussed,  and  the  sections 
on  pharmacology  and  effects  of  drugs  in- 
cluding analgesia  and  anesthesia  are  suc- 
cinct and  worthwhile.  The  delivery  of  pre- 
mature infants  is  covered  thoroughly  with 
emphasis  on  adequate  help  being  present. 

The  chapters  on  resuscitation  and  care 
of  the  premature  infant  have  good  illustra- 
tions and  are  concise.  They  are  followed  by 
a good  chapter  on  the  pathology  of  prema- 
turity. The  authors  conclude  the  book  with 
methods  to  decrease  the  incidence  of  pre- 
maturity through  improved  medical  facili- 
ties and  care.  The  book,  although  written 
primarily  for  the  obstetrician,  will  be  of 
interest  to  pediatricians,  pathologists,  and 
anesthesiologists  as  well. 

Paul  D.  Urnes,  M.D. 


Trade  Name  vs.  Generic 

Tolbutamide  has  been  studied  more  extensively  in  this  area  than  other 
drugs;  it  can  serve  as  a prototype.  In  1963  there  were  reports  in  the 
Canadian  literature  that  patients  placed  on  generic  tolbutamide  went  out 
of  diabetic  control.  This  was  restored  by  returning  them  to  the  trade-named 
product.  Some  recent  studies  indicate  that  minor  changes  in  the  amount 
of  inert  ingredients,  such  as  disintegrators  (in  the  form  of  starch  or  vee- 
gum),  can  alter  the  "available  equivalency"  even  though  the  chemical 
equivalency  is  intact.  Increasing  the  starch  from  6 to  7 per  cent  decreased 
the  disintegration  time  of  the  tablets  from  more  than  30  minutes  to  2.3 
minutes.  In  normal  volunteers  an  altered  tablet  with  one-half  the  amount 
of  disintegrator  gave  blood  levels  of  1.5  mg.  per  cent,  compared  to  7.0 
mg.  per  cent  for  the  routinely-produced,  trade-named  product.  The  blood 
sugar  at  90  minutes  fell  only  2 mg.  per  cent  with  the  generic  product,  com- 
pared to  14  mg.  per  cent  for  the  standard  item. 

Some  obvious  further  steps  were  undertaken  in  Canada  in  1965.  A 
pharmaceutical  analysis  of  26  lots  from  5 manufacturers  was  performed 
which  met  the  Food  and  Drug  Directorate  requirements  and  were  con- 
sidered generically  equivalent.  The  amount  of  a 500-mg.  tablet  dissolved 
in  simulated  gastric  juice  at  1 hour  ranged  from  15.3  mg.  to  333  mg.,  and 
the  tablets  disintegrated  in  from  1 second  to  83  seconds.  A double-blind 
study  on  25  stable  diabetic  patients,  who  had  been  on  the  drug  for  a 
prolonged  period,  demonstrated  only  1 brand  that  showed  a statistically 
significant  greater  effect  on  fasting  blood-sugar  levels.  They  concluded  that 
all  of  the  products  tested  were  satisfactory  and  that  the  differences  were 
not  of  clinical  importance.  These  studies  indicate  that  the  differences  in 
tablet  formulation  did  not  have  significant  therapeutic  effects  and  that 
chemical  equivalency  was  the  same  as  therapeutic.  ("Generic  Equivalency: 
Does  It  Exist?"  Maj.  Ronald  J.  Payne,  MC,  USA.  Medical  Annals  of  the  Dis- 
trict of  Columbia  [Sept.]  1969,  pages  490-492.) 


for  July,  1970 


85 


Abstracts  of  Board  Actions 

In  other  actions,  the  Board— 


(Continued  from  page  20) 


•postponed  action  on  the  employment  of  an  additional  full- 
time staff  person  in  the  area  of  health  care  delivery 
•approved  continuation  of  the  Usual  and  Customary  Fee  Com- 
mittee as  a Committee  of  the  Board 
•approved  a joint  study  by  the  Illinois  Pharmaceutical  As- 
sociation, Illinois  Veterinary  Medical  Association  and 
the  ISMS  of  the  availability  in  feed  stores  of  potent  drugs 
not  covered  by  prescription 

•approved,  in  principle,  the  establishment  of  the  Illinois 
Registry  of  Medical  Transcribers  and  referred  the  details 
of  this  proposal  to  the  Council  on  Medical  Service  for 
further  study 

•acted  upon  numerous  resolutions  being  submitted  to  the 
House  of  Delegates  (see  House  Abstracts  for  details) 

Board  Appointments  and  Authorizations: 

Mr.  James  Slawny,  director.  Public  Relations  and  Economics 
Division,  was  authorized  to  attend  the  11th  Annual  Western  Con- 
ference of  the  United  Foundations  for  Medical  Care  at  Palm 
Springs,  California  on  May  21-24,  to  secure  information  on  the 
operation  of  medical  foundations. 

Appointments  to  the  Ear,  Nose  & Throat  Health  Committee  were 
confirmed  as  follows: 

John  J.  Ballenger,  M.D.,  chairman,  Winnetka 
George  E.  Shambaugh,  Jr.,  M.D.,  Chicago 
Paul  H.  Holinger,  M.D.,  Chicago 
Richard  E.  Marcus,  M.D.,  Skokie 
(two  additional  members  from  downstate 
are  to  be  appointed) 

Consultants : 

Meyer  Fox,  M.D.,  Milwaukee,  Wisconsin 

Earl  Hartford,  Ph.D. , Northwestern  University  Medical 
School 

Maurice  M.  Hoeltgen,  M.D.,  Chicago 

Recommended  Dr.  Howard  Burkhead,  Evanston,  for  consideration 
as  a member  of  the  Radiation  Protection  Advisory  Council  in  the 
Department  of  Public  Health. 

The  1970-71,  Chairman  of  the  Ethical  Relations  Committee  was 
authorized  to  represent  the  ISMS  at  the  Third  National  Congress 
on  Medical  Ethics,  September  19-20,  Ambassador  Hotel,  Chicago. 

Approved  the  appointment  of  William  M.  Lees  and  Frank  J.  Jirka, 
Jr.,  as  representatives  of  the  ISMS  to  the  Illinois  Association 
of  the  Professions. 


Big  Brother  Needs  to  Diet 

"This  fiscal  year  the  U.S.  Government  must  pay  $17,000,000,000  in  in- 
terest on  the  public  debt.  In  1941  the  total  Federal  Budget  was  only  $14,- 
000,000,000.  So  it  is  costing  Uncle  Sam  $3,000,000,000  more  to  meet  his 
simple  interest  obligations  than  it  cost  him  to  run  the  whole  works  just 
prior  to  World  War  II."— Jenkin  Lloyd  Jones,  president.  Chamber  of  Com- 
merce of  the  United  States. 


86 


Illinois  Medical  Journal 


Leprosy  in  Ceylon 


By  Larry  Greenfield,  M.D./Los  Angeles 

Leprosy  has  always  struck  terror  into  the 
hearts  of  men  because  of  its  capriciousness 
of  attack,  its  mysterious  long  incubation 
period,  the  incidious  and  inexorable  prog- 
ress of  symptoms,  and  especially  because  of 
the  ulcers,  mutilation,  and  leonine  face  in  its 
final  stages.  In  many  cultures  a person  who 
contracted  leprosy  was  thought  to  have 
sinned  and  therefore  been  cursed.  In  primi- 
tive countries  the  disease  was  assumed  to 
be  punishment  imposed  by  the  spirits;  in 
India,  because  the  victims  or  their  parents 
were  believed  to  have  sinned,  they  were 
given  the  name  of  “majarog,”  curse  from 
the  Gods;  in  China,  the  victims  supposedly 
were  suffering  divine  punishment  for  a 
wrongdoing;  and  in  pre-Christian  Persia 
they  were  referred  to  as  “the  avoided  ones.”^ 
To  contact  leprosy  has  always  resulted  in 
being  labeled  an  outcast  by  family,  friends 
and  society,  and  suffering  widespread  social 
ostracism. 

This  dread  was  perpetuated  by  the  He- 
brew word  “Zaraath”  in  the  Mosaic  Code, 
and  by  its  erroneous  translation  as  “leprosy” 
—although  in  fact  it  meant  any  general 


Larry  D.  Greenfield,  M.D., 
is  currently  servings  his  in- 
ternship at  Los  Angeles  Coun- 
ty-University of  Southern 
California  Medical  Center 
where  he  will  begin  his  In- 
ternal Medicine  Residency. 
Three  months  of  his  fourth 
year  of  medical  school  was 
spent  on  the  S.S.  Hope,  Co- 
lombo, Ceylon.  He  received 
his  M.D.  from  the  Chicago 
Medical  School. 


scaly  condition,  whether  of  human  skin, 
clothing  or  walls. ^ The  term  came  to  imply 
religious  or  medical  uncleanliness,  to  be 
associated  with  ceremonial  exclusion.  In 
Israel  today,  “Zaraath”  still  connotes  terri- 
ble, dread  uncleanness.  During  pandemics 
of  true  leprosy  in  the  Middle  Ages,  the 
lexical  confusion  with  the  Biblical  “leprosy” 
continued  to  associate  the  disease  with  sin 
and  social  exclusion.^  With  all  this  his- 
torical background,  it’s  not  hard  to  under- 
stand the  present  myths,  superstitions,  fears 
and  ostracism.  Because  such  attitudes  to- 
ward leprosy  patients  still  persist  in  Ceylon 
they  suffer  severe  socio-economic  restric- 
tions. 

At  one  time  the  term  “leper”  or  its  equiva- 
lent in  another  language  (e.g.  OPO  in  Ni- 
gerian) signified  the  disease,  but  by  usage 
it  has  come  to  identify  the  patient.  The  5th 
International  Congress  for  Leprosy  1948, 
Havana,  Cuba,  passed  a resolution  aimed 
at  removing  the  social  stigma  from  the  vic- 
tims of  leprosy:  . . that  the  use  of  the 

term  ‘leper’  in  designation  of  the  patient 
with  leprosy  be  abandoned  and  the  person 
suffering  from  the  disease  be  designated 
‘leprosy  patient’.”^ 

Leprosy  Patients 

Among  Ceylon’s  12,000,000  people,  ap- 
proximately 4,300  leprosy  victims  have 
become  all  too  familiar  with  the  cruel 
ostracism  imposed  by  centuries  of  misun- 
derstanding. Prior  to  1945,  many  of  these 
unfortunates  would  have  been  sentenced  to 
spend  their  lives  in  either  Hendala  or  Bat- 


for  July,  1970 


87 


ticaloa,  Ceylon’s  Leprosaria,  with  no  hope 
of  ever  returning  to  society.  Approximately 
twenty  years  later,  the  250  new  patients 
found  yearly  are  now  treated  as  outpatients 
in  one  of  ten  clinics. 

Hendala,  built  in  1708,  now  houses  about 
850  patients  and  12  nurses.  The  150  females 
at  the  hospital  are  in  a separate  walled-olf 
area.  The  majority  of  the  700  men  in  the 
hospital  are  Sinhalese;  the  remaining  men, 
Tamils,  are  domiciled  in  one  building.  Each 
of  the  ten  wards  house  40  to  125  patients. 
The  buildings  are  little  more  than  walls 
supporting  a thatched  roof  with  no  windows 
or  screen  doors  to  restrict  the  free  move- 
ment of  dies  and  mosquitoes.  Many  of  the 
patients  are  severely  deformed.  The  worst 
have  lost  hands  or  feet;  others  have  severe 
contractions;  some  are  missing  digits,  while 
still  others  have  been  blinded  by  interstitial 
keratitis  or  xerophthalmia.  Some,  to  hide 
their  infected  sores  from  the  swarming  flies, 
huddle  under  dirty  blankets.  Because  of 
extreme  shortage  of  even  partially  trained 
personnel,  these  patients  receive  little  atten- 
tion to  their  physical  problems.  The  700  men 
must  use  limited  toilet  facilities  in  two 
malodorous  buildings,  each  of  which  is 
equipped  with  6 buckets  enqjtied  several 
times  a day. 

Patients  show  great  ingenuity  in  devis- 
ing methods  to  help  pass  away  the  hours 
at  the  hospital.  A few  patients  manage  a 
tiny  commissary,  while  others  make  special 
padded  sandals  for  their  fellow  patients. 
Still  others  spend  time  repairing  their 
clothes  and  helping  with  the  weekly  laun- 
dry. The  remainder  play  cards,  gamble 
illegally,  read  outdated  newspapers  and 
magazines,  or  sleep  the  day  away  due  to 
boredom.  The  150  patients  at  Batticaloa 
operate  a small  dairy  which  provides  a daily 
supply  of  milk. 

Function  of  the  Physiotherapist 

The  lone  hospital  physiotherapist  is  ex- 
pected to  explain  to  his  charges  the  attend- 
ant complications  of  their  affliction  as  well 
as  offer  the  required  therapy.  He’s  expected 
to  train  patients  suffering  with  peripheral 
neuropathy,  and  examine  their  hands  and 
feet  daily  for  unnoticed  thorns,  burns  or 
abrasions.  He  should  explain  to  the  patients 
that  pain  sensation  sensibly  limits  the 
strength  of  normal  hand  use.  However,  in 
the  presence  of  neuropathy,  one  cannot 
properly  judge  the  degree  of  force  applied 


and  it  may  result  in  injury.  To  emphasize 
the  exam’s  importance,  the  patient  should 
be  told  that  the  avoidance  of  these  every- 
day hazards  will  make  permanent  disfigure- 
ment less  likely. 

The  physiotherapist  has  at  his  disposal 
several  modalities  of  therapy  which  when 
properly  used  diminish  the  likelihood  of 
disfigurement.  Oil  massages,  for  example, 
would  help  prevent  contractures  of  flexion 
deformities,  and  may  even  help  straighten 
fingers  already  experiencing  contractures. 
In  relieving  joint  stiffness  and  increasing 
circulation  to  joints  in  the  fingers,  molten 
wax  therapy  could,  if  readily  available, 
assist  patients  in  the  performance  of  bene- 
ficial active  exercises.  In  the  event  that  these 
two  former  modalities  do  not  succeed,  the 
therapist  has  available  splints  or  casts  made 
of  plaster  or  coconut  shell.  These  should  be 
applied  twice  weekly  in  the  hope  of  modi- 
fying past  orthopedic  malalignment,  and 
of  preventing  any  further  contractures  in 
the  case  of  infection  and  lepra  reactions. 
Wax  and  oil  treatments  between  cast 
changes  could  soften  dry  cracked  skin  and 
relieve  joint  stiffness. 

The  treatment  of  ulcers  further  clutters 
the  physiotherapist’s  endless  schedule. 
Below  are  the  principles  that  should  be  fol- 
lowed: 

1.  Acute  stage  with  cellulitis:  rest,  eleva- 
tion and  penicillin. 

2.  Chronic  stage:  A shoe  molded  to  take 
the  weight  on  good  skin  and  hollowed 
to  spare  the  scar.  A soft  insole  with 
microcellular  rubber  is  an  advantage. 
In  severe  idcers,  the  sole  should  be 
rigid  in  its  entirety  and  have  a rocker.^ 
These  past  few  suggestions  are  similar 
to  official  thoughts  explained  in  a cir- 
cular issued  August  18,  1961,  by  the 
Leprosy  Campaign  Office  in  Colom- 
bo.® 

Because  of  the  hospital  patient  load  and 
limited  personnel,  the  full  benefits  of  the 
therapists  are  not  realized;  the  outpatient 
who  may  not  even  have  access  to  a therapist 
receives  even  fewer  benefits. 

Socio-Economic  Situation 

A dole  of  20  rupees  a month  is  available 
to  c]ualified  families  of  hospitalized  leprosy 
victims  through  Ceylon’s  Social  Service 
Agency.  The  infrequent  patient  who  is  dis- 
charged from  the  hospital  is  entitled  to  a 
lifetime  dole  of  50  rupees  monthly  if  he 


88 


Illinois  Medical  Journal 


meets  semi-annually  with  his  Leprosy  Cam- 
paign Officer  (similar  to  our  Probation 
Officer).  The  officer  should  examine  the  pa- 
tient lor  infectiousness,  try  to  ascertain  if 
the  patient  is  taking  his  medications  prop- 
erly, and  submit  his  findings  on  an  official 
form  to  the  Main  Leprosy  Campaign  Office 
in  Colombo.  Many  patients  ready  for  dis- 
charge refuse  to  leave  the  hospital;  they 
know  all  too  well  that  50  rupees  a month 
cannot  support  them,  but  most  significantly, 
they  know  the  prevailing  repressive  social 
attitudes.  Most  patients  are  satisfied  and 
content  to  be  housed,  fed,  and  clothed  at 
government  expense;  albeit,  at  a level  bare- 
ly above  substinence. 

Dr.  Paul  de  Fonseka  is  almost  singularly 
dedicated  to  upgrading  the  socio-economic 
situation  of  leprosy  patients.  He  is  superin- 
tendent of  Ceylon’s  Leprosy  Campaign 
which  includes  two  leprosaria,  nine  small 
leprosy  clinics  throughout  Ceylon  and  the 
Main  Leprosy  Clinic  at  Colombo  General 
Hospital. 

The  Leprosy  Clinic 

The  main  clinic,  as  a service  to  patients, 
is  open  every  day  except  Poya  Day  and 
Pre-Poya  afternoon.  To  avoid  the  stigma 
of  leprosy,  the  clinic  is  designated  as  a 
“Special  Skin  Clinic”  or  “Room  19.”  The 
clinic  staff  includes  a nurse,  a bacteriologist 
who  performs  skin  biopsies,  an  unlicensed 
pharmacist  and  several  assistants.  Every  new 
clinic  patient  with  the  aid  of  an  assistant, 
completes  a “leprosy  survey  form”  that  is 
similar  to  our  history  and  physical.  This 
survey  encompasses  the  duration  of  the 
disease,  the  social  background  of  the  patient 
and  his  family,  and  a list  of  possible  con- 
tacts which  are  of  statistical  value  and 
importance  to  the  P.H.I.  and  the  Leprosy 
Campaign  Office  in  leprosy  control.  Also 
included  is  an  extensive  variety  of  clinical 
manifestations  of  leprosy  which  are  illus- 
trated via  symbols  on  a pair  of  sketches  of 
the  body. 

Following  this  initial  work-up,  the  pa- 
tient is  examined  by  Dr.  Fonseka,  who 
either  confirms  or  disallows  the  diagnosis. 
If  confirmed,  a skin  biopsy  is  done  and 
examined  for  AFB,  medicine  is  prescribed 
and  dispensed  to  the  patient,  and  he  is 
given  his  next  clinic  appointment.  To  fur- 
ther avoid  the  stigma  of  leprosy  and  to 
help  the  patient  retain  his  position  in  so- 
ciety, only  severely  ill  patients  are  sent  to 


a Leprosaria  and  then  only  for  the  shortest 
possible  time. 

Treatment 

The  suggested  course  of  treatment  with 
DDSD  (Diamino-Diphenyl-Sulphone)  or 
Dapsone  is  described  in  detail  in  “Leprosy 
Campaign  Field  Circular  No.  1/62,”  writ- 
ten by  Dr.  Fonseka.  The  initial  dosage  of 
DDS  should  be  25  mg.  q.o.d.  for  one 
month,  50  mg.  q.o.d.  in  the  second  month, 
and  for  the  third  month,  50  mg.  q.o.d.  for 
six  days  with  the  drug  withheld  on  the 
seventh  day.  After  these  three  months,  the 
patient  should  receive  only  iron  tonics  and 
Vitamin  D for  two  weeks.  Subsequently, 
DDS  is  to  be  resumed  as  in  the  third 
month  of  therapy,  for  at  least  two  years 
after  the  case  is  declared  arrested.  The  cri- 
terion for  arrest  are: 

“1.  By  routine  methods  of  examination 
no  bacilli  have  been  found  in  smears 
from  the  skin  and  nasal  mucosa  for 
at  least  six  months,  skin  examination 
having  been  performed  periodically 
from  several  sites,  (monthly) 

2.  There  is  no  visible  infiltration  of  the 
lesions,  i.e.  all  lesions  have  become 
flat  and  are  not  raised  either  in  the 
center  or  marginally  for  at  least  six 
months. 

3.  There  has  been  no  alteration  in  tex- 
ture, color  or  size  of  the  lesions, 
and  there  has  been  no  erythema  for 
at  least  six  months. 

4.  No  fresh  lesions  or  extension  of  exist- 
ing lesions  has  taken  place  for  a simi- 
lar period. 

5.  Anesthesia  has  remained  stationary, 
i.e.  no  increase  or  decrease  of  cutane- 
ous sensibility  during  a similar  pe- 
riod. 

6.  No  nerve  tenderness  or  pain  for  a 
similar  period.’”^ 

Dapsone  is  not  without  its  varying  de- 
grees of  side  reactions.  Mild  reactions,  such 
as  nausea  and  vomiting  may  be  alleviated 
by  giving  DDS  after  a meal  with  sodium 
bicarbonate.  A less  frequent  mild  reaction, 
neurodermatitis,  beginning  with  itching 
and  desquamation  requires  that  the  drug  be 
halted.  When  the  drug  is  discontinued.  Vi- 
tamin B and  Cal-Lactate  mixture  should 
be  administered  until  the  reaction  has  sub- 
sided. 

The  less  frequent  but  more  severe  reac- 
tions such  as  hepatitis  and  psychosis  neces- 
sitate stoppage  of  the  drug  and  instituting 
muscular  injections  of  Vitamin  B Complex 


for  July,  1970 


89 


and  anthiomalin  (1.5cc)  every  other  day  for 
three  days. 

Medical  Profession  Lacks  Concern 

The  control  of  leprosy  in  Ceylon  re- 
quires a dual  approach  of  trying  to  over- 
come centuries  of  myths,  superstition,  fears, 
dreads  and  disinterest,  and  hopefully  insti- 
tuting new  policies  and  training  new  per- 
sonnel. According  to  Dr.  Fonseka,  the  Cey- 
lonese medical  profession  by  its  own  fears 
and  disinterest  contributes  to  the  perpetua- 
tion of  ancient  myths  and  superstitions. 

Internists  and  surgeons  are  quite  con- 
scious of  the  prestige  and  respect  they  com- 
mand from  the  Ceylonese  public.  Under  the 
government  system  of  socialized  medicine, 
most  of  Ceylon’s  physicians  are  salaried  ac- 
cording to  years  of  employment.  Even  with 
such  salary  guarantees,  the  fear  of  loss  of 
prestige  and  respect  is  so  great  that  it  is 
the  rare  doctor  who  devotes  any  time  to 
leprosy  patients.  This  results  in  failure  to 
treat  the  effects  of  leprosy.  The  most  notice- 
able is  disfigurement,  which  is  treatable  only 
by  neurosurgery,  orthopedic  surgery,  oph- 
thalmic surgery  and  plastic  surgery.  The 
surgeons  claim  they  are  not  disinterested 
but  desire  only  certain  changes  in  Hendala’s 
operating  suite.  Dr.  Fonseka  claims  that  if 
these  changes  could  be  made,  they  woidd 
again  delay.  Nurses  and  other  paramedical 
help  mirror  the  physicians’  attitudes,  as  is 
evidenced  by  lack  of  such  personnel  at  the 
various  leprosy  establishments. 

On  the  contrary,  Ceylonese  physicians 
have  no  reservations  about  treating  patients 
with  hepatitis,  dysentery,  tuberculosis  or 
other  medical  diseases,  or  of  performing 
orthopedic,  cardiac,  and  neurologic  surgery 
on  non-leprous  patients. 

An  even  more  serious  limitation  of  the 
care  of  leprosy  patients  results  from  lack  of 
concern  of  the  Health  Ministry.  On  several 
occasions  they  have  attempted  to  limit  the 
already  inadequate  budget  of  the  leprosy 
campaign. 

The  major  diagnostic  problem  of  leprosy 
in  America  is  the  low  index  of  suspicion 
among  physicians.  Even  though  fears  and 
dreads  of  leprosy  do  exist  among  a small 
percentage  of  laymen,  leprous  and  non- 
leprous  patients  receive  the  same  thorough 
care  from  the  physician.  If  a patient  needs 
special  care  or  surgery,  he  can  be  referred 
to  the  U.S.  Leprosarium  in  Carville,  La. 
or  to  the  U.S.  Public  Health  Service  clinics 


in  San  Francisco  or  San  Pedro,  California 
and  New  York  City. 

While  trying  to  uproot  ancient  myths  and 
fears.  Dr.  Fonseka  believes  that  hospital 
based  leprosy  centers  managed  by  campaign 
officeis  woidd  be  instrumental  in  further 
leprosy  control  efforts.  In  small  hospitals 
these  “leprosy  treatment  centers”  could  dis- 
pense medicines  prescribed,  massages  and 
exercises,  and  apply  casts  and  splints.  Larger 
centers  could  provide  physiotherajry  and 
reconstructive  surgery.  Officers  at  all  of 
these  centers  should  not  only  instruct 
groups  of  patients  in  the  prevention  and 
care  of  leprosy’s  complications,  but  work 
closely  with  the  local  Public  Health  In- 
spector to  register,  examine  and  treat  con- 
tacts. Cod  liver  oil,  worm  treatment,  and 
milk  (in  the  case  of  children)  should  be  the 
basic  treatment  of  contacts  of  non-infections 
and  infectious  cases;  in  the  latter  case  gradu- 
ated doses  of  Dapsone  should  also  be  given 
on  the  following  schedule: 

5-  9 yrs.  of  age  lU  mg  \ 

10-1-1  yrs.  of  age  15  mg  ( 2-3  X weekly 

15-19  yrs.  of  age  20  mg  ) 

Leprosy  Control 

Better  leprosy  control  will  require  the 
effective  use  of  every  available  means  of 
communication;  consistent  use  of  radio, 
films,  newspapers,  leaflets,  posters,  adver- 
tisements, and  discussions  with  various  re- 
ligious and  rural  societies.  The  theme,  ac- 
cording to  Dr.  Fonseka,  should  emphasize 
sympathy  and  understanding  for  leprosy  pa- 
tients, not  social  ostracism  dne  to  out- 
moded myths  and  superstitions. 

As  Dr.  Fonseka  says:  “The  hope  of  re- 
covery and  restoration  to  society  is  the 
strongest  incentive  to  early  isolation  and 
early  treatment,  and  those  who  work  to 
remove  that  hope  only  increase  the  dif- 
ficulty of  controlling  leprosy.” 

In  conclusion,  the  establishment  of  more 
leprosy  centers  staffed  with  interested  per- 
sonnel, with  a consistent  public  education 
program  will  all  contribute  to  better  lep- 
rosy control. 

What  is  undoidjtedly  true  in  Ceylon  for 
leprosy  is  true  to  a greater  or  lesser  degree 
for  any  disease  in  any  country  where  myths 
rather  than  facts  prevail. 

References 

1.  Hasselblad.  Leprosy.  A Present  Day  Under- 
standing, American  Leprosy  Mission,  Inc.,  New 
York,  N.Y.,  Sept.  I960. 


90 


Illinois  Medical  Journal 


2.  Browne,  S.  G.,  Internat.  J.  Leprosy,  1963,  13-229. 

3.  Goldman,  L.,  Arch.  Derm.,  1966,  93-744. 

4.  Hasselblad,  Leprosy.  A Present  Day  Under- 
standing, American  Leprosy  Mission,  Inc.,  New 
York,  N.Y.,  Sept.  1960. 

5.  Report  of  the  Committee  on  Therapy.  Seventh 
Internat.  Congress  of  Leprology,  Tokyo,  1958. 

6.  Leprosy  Campaign  Office,  Colombo.  Circular, 
8-18-61. 

“1.  Use  special  handles  and  holders  for  hot 
articles. 

2.  Inspect  their  own  hands  and  feet  daily  for 
thorns  or  blisters.  Special  attention  needs 
to  be  paid  to  employment  such  as  cooking 
and  heavy  rough  work.  To  prevent  these 
problems  a change  of  occupation  selected 
either  by  the  physiotherapist  or  social 
worker  is  needed. 

3.  Dress  and  splint  every  wound  and  keep  it 
splinted  with  coconut  shell  in  a func- 
tional position  until  it  heals. 

4.  Wear  well  fitting  shoes  or  sandals  and 
avoid  any  shoes  made  with  nails. 

5.  Rest  the  hands  during  lepra  reactions  and 
when  they  are  swollen.  A splint  should  be 
provided  for  such  occasions. 

6.  When  paralysis  and  clawing  occur  they 
should  begin  a daily  routine  of  oil  mas- 
sage and  exercise  designed  to  keep  fingers 
fully  mobile. 

7.  As  part  of  this  educational  program,  the 
patient  may  need  advice  about  a form  of 
employment  that  will  not  harm  his  hands 
or  over-tax  his  feet.” 

7.  Fonseka,  Paul  de,  M.D.,  Information  about 
Leprosy,  Department  of  Health,  Colombo,  Cey- 
lon, 1960. 


Obituaries 

* Chester  Coggeshall,  Chicago,  died  June 
2 at  the  age  of  61.  He  was  a founder  of 
the  Chicago  Diabetes  Association. 

*Alice  W.  Hamby,  Elmhurst,  died  in  April 
at  the  age  of  46. 

*Harry  Jackson,  Chicago,  died  April  22 
at  the  age  of  89.  He  was  an  assistant  pro- 
fessor of  surgery  at  Northwestern  Univer- 
sity. 

*Fred  P.  Long,  Peoria,  died  April  26  at 
the  age  of  66.  He  was  the  Peoria  City- 
County  Health  Director  since  1950. 

* James  B.  O’Neill,  Palos  Heights,  died 
April  25  at  the  age  of  53.  Dr.  O’Neill  was 
a heart  specialist. 

*Michael  I.  Reiffel,  Chicago,  died  May  30 
at  the  age  of  75.  He  was  a member  of  the 
ISMS  Fifty-Year  Club. 

•Indicates  member  of  Illinois  State  Medical  Society. 


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Phone:  312-878-9700 
4840  NORTH  MARINE  DRIVE 
CHICAGO,  ILLINOIS  60640 

J.  Dennis  Freund,  M.D.,  Medical  Director 


for  July,  1970 


91 


THE  VIEW  BOX 


Ulcer 

Re- 

lief! 


Dicarbosil 


ANTACID 

Your  ulcer  patients  and 
others  will  respond  favorably 
to  it.  Specify  DICARBOSIL 
144's  — 144  tablets  in  12  rolls. 


ARCH  LABORATORIES 

319  South  Fourth  Street.  St.  Louis.  Missouri  63102 


COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 

STARTING  DATES— 1970 

SPECIALTY  REVIEW  COURSE  IN  SURGERY,  Part  I,  August  10 
SPECIALTY  REVIEW  COURSE  IN  MEDICINE,  Part  I,  Sept. 
14  & 21 

SPECIALTY  REVIEW  COURSE  IN  THORACIC  SURGERY  Sept.  21 
SPECIALTY  REVIEW  COURSE  IN  UROLOGY,  Three  Days,  Oct. 
14 

ADVANCED  PERIPHERAL  VASCUUR  SURGERY,  One  Week, 
July  6 

PROCTOSCOPY  & VARICOSE  VEINS,  One  Week,  September  14 
SURGERY  OF  THE  HAND,  Three  Days,  September  15 
SURGERY  OF  HEAD  & NECK,  One  Week,  September  21 
SURGERY  OF  STOMACH  & DUODENUM.  One  Week,  Sept.  28 
VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  July 
27,  Oct.  5 

ADVANCES  IN  GYNECOLOGY  & OBSTETRICS,  One  Week, 
Sept.  28 

PEDIATRIC  SURGERY,  One  Week,  September  28 
PULMONARY  FUNCTION  TESTS,  3 Days,  July  8 
GENERAL  PRACTICE  REVIEW  COURSE,  One  Week,  Sept.  14 
BASIC  ELECTROCARDIOGRAPHY,  One  Week,  October  5 
BASIC  INTERNAL  MEDICINE,  One  Week,  October  12 
RADIOISOTOPES,  One  or  Two  Weeks,  Request  Dates 
INHALATION  & REGIONAL  ANESTHESIA,  Request  Dates 
Information  concerning  numerous  other 
continuation  courses  available  upon  request, 

TEACHING  FACULTY 

Attending  Staff  of 
Cook  County  Hospital 

Address: 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 


(Continued  from  page  70) 

Diagnosis : 

Diagnosis  is  left  middle  cerebral  artery 
occlusion.  The  arrow  points  to  the  site  of 
almost  a complete  occlusion  of  the  left  mid- 
dle cerebral  vessel.  The  area  which  is  norm- 
ally supplied  by  the  middle  cerebral  artery 
is  completely  avascular  and  is  seen  between 
the  posterior  and  cerebral  circulation  in- 
feriorly  and  the  anterior  cerebral  circula- 
tion superiorly.  Films  B and  C reveal  early 
retrograde  filling  high  over  the  convexity 
from  the  anterior  cerebral  artery.  The  col- 
lateral flow  enters  in  the  low  and  posterior 
position  to  fill  the  posterior  temporal 
branch  of  the  middle  cerebral  artery  from 
the  posterior  cerebral  artery  via  pial  anas- 
tomoses. In  Figure  C we  see  that  the 
original  bare  area  demonstrates  vascularity 
which  has  resulted  from  collateral  circula- 
tion and  are  undoubtedly  aiding  the  patient 
in  the  degree  of  recovery  which  has  been 
demonstrated  clinically. 

There  are  three  principle  cranial  collat- 
eral pathways:  1)  through  the  Circle  of 
Willis;  2)  external  to  internal  carotid  anas- 
tomosis, a)  ophthalmic  artery  reversed  flow 
(most  commonly  observed),  b)  middle 
meningeal  branch  of  the  external  carotid 
to  the  meningeal  branch  of  the  cerebral 
artery:  3)  over  the  surface  of  the  brain’s  so- 
called  meningeal  or  pial  anastomoses  be- 
tween and  among  the  three  major  cerebral 
arteries. 

These  collateral  pathways  exist  awaiting 
demand  and  enlarge  as  demand  for  flow 
rate  and  volume  increases. 

Reference 

Love,  L.  Hill,  B.  J.,  Larson,  S.  J.  Raimondi,  A. 
J.,  and  Lescher,  A.  J.:  "Cranial  Collateral  Pathways 
in  Stroke  Syndrome.”  American  Journal  of  Roent- 
genology, Radium  Therapy  and  Nuclear  Medicine, 
Vol,  98,  No.  3,  pages  637-646,  1966. 


"The  Treatment  of  Parkinson  with  Levo- 
dopa" a 14  minute,  color,  sound  presenta- 
tion covers  the  symptoms  and  bio-chemical 
aspects  of  the  disease,  prior  treatment,  the 
establishment  of  dosage  schedules,  and 
complications  of  therapy.  The  film  may  be 
obtained  by  contacting  Eaton  Medical  Film 
Library,  Eaton  Laboratories,  Norwich,  New 
York  13815  or  any  Eaton  sales  representa- 
tive. 


92 


Illinois  Medical  Journal 


Illinois  Medical  Journal 

volume  13S,  number  2 august,  1970 


Editor  

Managing  Editor  

Medical  Progress  Editor 

Editorial  Assistant  

Advertising  Manager  ... 
Executive  Administrator 


Theodore  R.  Van  Dellen,  M.D. 

Richard  A.  Ott 

Harvey  Kravitz,  M.D. 

Michaelyn  Sloan 

John  A.  Kinney 

Roger  N.  White 


CONTENTS 


ILLINOIS  STATE 
MEDICAL  SOCIETY 

360  N.  Michigan  Ave.,  Chicago,  60601 
OFFICERS 

J.  Ernest  Breed,  President 

55  East  Washington  Street,  Chicago  60602 
L.  T.  Fruin,  President-Elect 
5 Citizen's  Square,  Normal,  61761 
George  C.  Shropshear,  1st  Vice-President 
1525  East  53rd  Street,  Chicago,  60615 
C.  J.  Jannings,  111,  2nd  Vice-President 
101  East  Center  Street,  Fairfield,  62837 
Jacob  E.  Reisch,  Secretary-Treasurer 

1129  South  2nd  Street,  Springfield  62704 
Paul  W.  Sunderland,  Speaker 

214  North  Sangamon  St.,  Gibson  City,  60936 
Andrew  J.  Brislen,  Vice-Speaker 

6060  South  Drexei  Blvd.,  Chicago  60637 
Willard  C.  Scrivner,  Chairman  of  the  Board 
4601  State  Street,  East  St.  Louis,  62205 


TRUSTEES 

Joseph  L.  Bordenave,  1st  District  (1971) 

1665  South  Street,  Geneva,  60134 
William  A.  McNichols,  Jr.,  2nd  District  (1971) 
101  West  First  Street,  Dixon,  61021 
Fredric  D.  Lake,  3rd  District  (1972) 

1041  Michigan  Avenue,  Evanston,  60202 
James  B.  Hartney,  3rd  District  (1973) 

410  Lake  Street,  Oak  Park,  60302 
Frank  J.  Jirko,  3rd  District  (1971) 

1507  Keystone  Ave.,  River  Forest,  60305 
William  M.  Lees,  3rd  District  (1971) 

6518  N.  Nokomis,  Lincolnwood,  60646 
Frederick  E.  Weiss,  3rd  District  (1973) 

15643  Lincoln  Avenue,  Harvey,  60426 
Warren  W.  Young,  3rd  District  (1972) 

10816  Parnell  Avenue,  Chicago,  60628 
Fred  Z.  White,  4th  District  (1973) 

723  North  Second  St.,  Chillicothe,  61523 
A.  Edward  Livingston,  5th  District  (1973) 

219  North  Main,  Bloomington,  61701 
J.  Mather  Pfeiffenberger,  6 District  (1972) 

State  & Wall  Streets,  Alton,  62002 
Arthur  F.  Goodyear,  7\\\  District  (1973) 

142  East  Prairie  Avenue,  Decatur,  62523 
Eugene  P.  Johnson,  8th  District  (1973) 

22  West  Main  Street,  Casey,  62420 
Charles  K.  Wells,  9th  District  (1972) 

117  North  10th  Street,  Mt.  Vernon,  62864 
Willard  C.  Scrivner,  10th  District  (1972) 

4601  State  Street,  East  St.  Louis,  62205 
Joseph  R.  O'Donnell,  11th  District  (1971) 

4^  Park,  Glen  Ellyn,  60137 
Edward  W.  Cannady,  Trustee-at-Large 
4601  State  Street,  East  St.  Louis,  62205 


CLINICAL  ARTICLES 

VV^hy  does  asthma  occur  at  night? 

Donald  L.  Unger,  M.D,  J23 

yVrgentaihne  carcinoma  (carcinoid  tumor)  involving 
the  ampnlla  ol  Vater 

Mario  Stefanini,  M.D.,  Joint  E.  Vrbas,  M.D.,  and 

Fred  I..  Crorkelt,  M.D ..  13Q 

The  doctor-patient  dyad:  An  interpersonal  relation- 
ship model 

II.  II.  Garner,  M.D 1 33 

An  analysis  ol  500  consecutive  cases  ol  acute 
appenilicitis  in  a metropolitan  charity  hosjrital 
Smliil  M.  Sethi,  M.D.,  Takayoshi  Mafsiida,  M.D., 

L.  Beaty  Pemberton , M.D.,  and  E.  Lee  Strohl,  M.D 147 

SURGICAL  GRAND  ROUNDS 

Intermittent  jaundice  125 

MEDICAL  PROGRESS 

Commnnity  aspects  ol  epilepsy 

Louis  D.  Boshes,  M.D.,  and  Hans  O'.  Kienast,  M.D.  140 

SPECIAL  ARTICLES 

Illinois’  Anatomical  Gilt  Act 

Frank  Pfeifer,  ISMS  legal  counsel  154 

Educating  the  total  health  team 

June  Blythe  170 

FEATURES 

Bine  Shield  Report  97 

The  President’s  Page  116 

Clinics  lor  Crippled  Children  119 

OIritnaries  124 

The  View  Box  129 

New  Pharmaceutical  Specialties  132 

Membership  Fornm  150 

The  Doctor’s  Library  152 

Editorials  159 

Illinois  Medical  Assistants  Association  160 

Socio-Economic  News  161 

Public  Allairs  Library  163 

Legislatively  Speaking  163 

Film  Review's  169 

Meeting  Memos  178 

(Cover  story  on  page  102) 

Publications  Committee  Editorial  Board 


Microfilm  copies  of  current  as  well  as  some  back 
issues  of  the  Illinois  Medical  Journal  may  be 
purchased  from  Xerox  University  Microfilms,  300 
N.  Zeeb  Road.  Ann  Arbor.  Mich.,  48106. 


Jacob  E.  Reisch,  M.D.,  Chairman 
A.  Edward  Livingston,  M.D. 
Warren  W.  Young,  M.D. 


Harvey  Kravitz,  M.D. 
Chairman 

Charles  Mrazek,  M.D. 
C.  J.  Mueller,  M.D. 


Frederick  Steigman,  M.D. 
Frederick  Stenn,  M.D. 
Arkell  M.  Vaughn,  M.D. 


Published  monthly  by  the  Illinois  State  Medical 
Society.  360  N.  Michigan  Ave.,  Chicago,  111.,  60601. 
Copyright  1970.  The  Illinois  State  Medical  Society. 

Subscription  $5.00  per  yoHr,  in  advance,  postage 
prepaid,  for  the  United  States,  Cuba,  Puerto  Rico, 
Philippine  Islands  and  Mexico.  $7.50  per  year  for 
all  foreign  countries  included  in  the  Universal  Postal 
Union.  Canada  $5.50  U.S.  Single  current  copies 
available  at  75c. 

Second  class  postage  paid  at  Chicago,  111.  and  at 
additional  mailing  offices.  When  moving  please  notify 


Journal  office  of  new  address  including  old  mailing 
label  with  notification,  if  possible.  POSTMASTER: 
Send  notice  on  form  No.  3579  to  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave.,  Chicago, 
III.  60601. 

Pharmaceutical  advertising  must  be  approved  by 
the  ISMS  Publications  Committee.  Other  advertising 
accepted  after  review  by  Publications  Committee  or 
Board  of  Trustees.  All  copy  or  plates  must  reach  the 
Journal  office  by  the  fifteenth  of  the  month  preceding 
publication.  Rates  furnished  upon  request. 


Original  articles  will  be  considered  for  publication 
with  the  understanding  that  they  are  contributed  only 
to  the  Illinois  Medical  Journal.  The  ISMS  denies 
responsibility  for  opinions  and  statements  expressed  by 
authors  or  in  excerpts,  other  than  editorial  or  allied 
views  or  statements  which  reflect  the  authoritative 
action  of  the  ISMS  or  of  reports  on  official  actions, 
policies  or  positions.  Views  expressed  by  authors  do 
not  necessarily  represent  those  of  the  Society;  any 
connection  with  official  policies  is  coincidental. 


for  August,  1970 


101 


Physicians  Placement  Service 


WHITESIDE  COUNTY:  Sterling-Rock 

Falls;  population:  30,000.  Salary:  open 
$I8,000-$20,000.  Opportunity  for  partner- 
ship after  three  years.  Building  10  years 
old.  Erdman  design.  Thirty  additional  doc- 
tors in  community.  Hospital  one-half  block 
from  office;  180  beds.  AgTiculture  and  in- 
dustry. Forty  churches.  Grade  and  high 
schools.  Good  airline  service.  For  further 
information  contact:  J.  David  Burnstine, 
M.D.,  14  East  Miller  Road,  Sterling.  Phone: 
815-625-2575. 


WOODFORD  COUNTY:  Minonk;  popu- 
lation: 2,000.  Trade  area:  10,000.  Only  three 
physicians  in  10-mile  radius.  Twenty-five 
miles  from  Streator  Hospital.  New  air-con- 
ditioned 10-room  clinic.  Agricultural  area. 
Protestant  and  Catholic  churches.  Grade 
and  high  schools.  Three  colleges  within 
25  miles.  Three  nearby  country  clubs.  Sal- 
ary for  one  year;  partnership  thereafter. 
For  further  information  contact:  H.  T.  Bar- 
rett, M.D.,  Minonk. 


Reduce  Cell  Damage  from  Anti-Leukemic  Drugs 


Halothane  and  nitrous  oxide,  two  com- 
mon anesthetics,  have  been  found  to  re- 
duce damage  to  healthy  cells  by  anti-leu- 
kemic drugs.  Experiments  with  5,000 
laboratory  mice  led  to  this  conclusion.  Dr. 
David  L.  Bruce,  associate  professor  of  anes- 
thesia in  the  Northwestern  University 
Medical  School,  Chicago,  announced. 

If  the  results  ultimately  are  confirmed  in 
humans,  a significant  contribution  hopeful- 
ly will  have  been  made  to  the  treatment 
of  leukemia  by  permitting  more  vigorous 
and  successful  therapy  with  arabinosyl  cy- 
tosine (ara-C)  and  vinblastine,  two  potent 
anti-leukemic  drugs  which  destroy  malig- 
nant cells,  but  unfortunately  are  often  toxic 
to  healthy  ones. 

In  essence,  Bruce  and  two  associates, 
Drs.  Hsui-San  Lin  and  W.  R.  Bruce  of  the 
Ontario  Cancer  Institute,  Toronto,  discov- 
ered that  light  anesthesia  with  either  halo- 
thane or  nitrous  oxide  reduced  significantly 
the  destruction  of  normal  cells  by  ara-C  or 
vinblastine.  Their  experiments  with  some 
5,000  laboratory  mice  showed  no  reduc- 
tion in  the  ability  of  anti-cancer  agents  to 
kill  malignant  cells  when  the  cancer  cells 
were  given  concurrently  with  the  anesthe- 
tics. 

Dr.  D.  L.  Bruce  said  the  experiments 


demonstrate  that  halothane  or  nitrous 
oxide  given  concurrently  with  either  of  the 
chemotherapeutic  agents  will  protect 
healthy  cells  from  toxicity  without  reduc- 
ing the  effectiveness  of  the  anti-cancer 
drugs  on  leukemic  bone  marrow  cells. 

The  U.S. -Canadian  findings  are  published 
in  the  June  issue  of  Cancer  Research. 

In  their  research,  the  three  scientists  va- 
porized the  cages  of  leukemic  mice  with 
the  two  anesthetic  agents  and  later  admin- 
istered ara-C  and  vinblastine  to  the  ani- 
mals. The  scientists  later  sacrificed  the  mice 
and  found  that  the  anesthetic-cancer  drug 
combination  had  no  effect  on  normal  bone 
marrow  cells  and  that  the  effectiveness  of 
the  cancer  drugs  on  malignant  cells  was 
unimpaired. 

By  contrast,  damage  to  healthy  cells  or 
the  spread  of  malignant  cells  was  observed 
in  other  groups  of  mice,  who  had  received 
the  anesthetics  alone,  one  cancer  drug 
alone,  or  neither  the  anesthetics  nor  the 
cancer  drugs. 

The  scientists  concluded  from  their  studies 
that  protection  of  normal  calls  by  anesthe- 
tic-cancer drug  combinations  may  indicate 
a general  phenomenon  whereby  anesthe- 
tics increase  the  selectivity  of  cytotoxic 
drugs  by  protecting  normal  cells  against 
them. 


ON  THE  COVER 

This  month's  cover  depicts  the  asthma  sufFerer,  who  according  to  Donald  L.  Unger,  M.D., 

in  his  article  on  page  123,  "Why  does  asthma  occur  at  night?"  finds  the  night  hours  the 

most  difficult.  Cover  art  by  Bob  Solomon  of  Star  Litho-Art. 

The  September  issue  of  the  Illinois  Medical  Journal  will  feature  two  other  relevant  articles 

in  these  times  of  air  pollution:  "Allergic  Rhinitis  and  Air  Pollution:  A Double-Blind  Crossover 
Analysis  of  Two  Oral  Nasal  Decongestants,"  by  Drs.  Peter  S.  Mayer,  and  Arthur  E.  Savitt;  and 
"Meteorologic  Factors  in  the  Fallout  of  Pollens  and  Molds,"  by  Drs.  Eugenia  and  Herman  Heise. 
In  addition.  Dr.  Kenneth  H.  Schnepp's  article,  "Licensure  Problems  in  Illinois,'  should  be  quite 
informative  in  view  of  current  concern  with  licensing  problems.  A second  article  will  give 
further  elucidation  on  this  topic. 


1U2 


Illinois  Medical  Journal 


National  Accounts  Outlined 

The  National  Association  of  Blue  Shield  Plans  has 
requested  that  all  Blue  Shield  Plans  provide  a 
comprehensive  usual  and  customary  benefit  pro- 
gram that  can  be  used  in  national  account  pro- 
posals. The  National  Association  of  Blue  Shield 
Plans’  specifications  for  this  program  include  t-wenty 
different  benefit  categories.  The  first  twelve  of 
these  are  considered  standard  benefits  and  the 
remaining  eight  are  considered  optional. 

Illinois  Medical  Service  will  offer  twelve  standard 
benefits  (plus  variations  within  each  benefit)  by 
September  1,  1970. 

Benefits  under  a national  contract  will  vary  from 
group  to  group  only  in  that  they  may  purchase 
h the  optional  riders.  Every  contract  will  include: 

1.  Surgical  Service:  operative  or  cutting  proce- 
dures, the  treatment  of  fractures  or  disloca- 
tions, and  certain  endoscopic  and  other  pro- 
cedures. 

2.  Anesthesia  Service:  anesthesia  administered 
in  conneetion  with  services  covered  under  the 
contract  when  ordered  by  the  attending  phy- 
sician. 

3.  Radiation  Therapy  Service:  the  treatment  of 
diseases  by  x-ray,  radium  or  radioactive  iso- 
topes. 

4.  Diagnostic  X-Ray:  an  x-ray  examination,  in- 
cluding interpretation  and  report. 

5.  Laboratory  and  Pathology:  laboratory  and 
pathological  examinations. 

6.  In-Hospital  Medical  Care:  any  medical  treat- 
ment of  a condition  not  related  to  surgical  or 
maternity  care. 

7.  In-Hospital  Medical  (TB,  Mental,  Drug  Addic- 
tion and  Alcoholism):  benefits  are  provided 
for  the  treatment  of  pulmonary  tuberculosis, 
mental  disorders,  drug  addiction  and  chronic 
alcoholism. 

8.  Maternity  care:  benefits  are  provided  for  ma- 

I ternity  services,  including  necessary  pre-natal 

and  post-natal  care,  furnished  to  the  employee 
or  the  spouse  of  an  employee  enrolled  on  a 
family  certificate  only  after  such  certificate 
has  been  in  force  for  270  consecutive  days. 


9.  Out-Patient  Emergency  Care:  those  necessary 
services  performed  by  a physician  for  an 
accidental  injury  or  for  the  initial  visit  at 
the  onset  of  a medical  emergency. 

10.  Consultations:  benefits  are  provided  for  the 
service  of  another  physician,  when -requested 
by  the  attending  physician  who  is  in  charge 
of  the  case.  Benefits  are  provided  only  on 
an  in-patient  basis. 

11.  Out-Of-Hospital  Diagnostic  X-ray,  Labora- 
tory and  Pathological  Services:  benefits  for 
these  diagnostic  services  are  available  only 
to  members  who  are  not  registered  bed  pa- 
tients. 

12.  Physical  Therapy:  the  treatment  of  disease  or 
injury  by  physical  means  such  as  massage, 
hydrotherapy,  heat  or  similar  modalities  as 
may  be  prescribed  by  a physician. 

A Usual  and  Customary  prograrn,  properly 
carried  out,  and  with  the  continued  cooperation 
of  the  medical  profession,  will  accomplish  several 
long  desired  objectives:  a greater  return  for  phy- 
sicians from  third-party  agencies;  a more  ap- 
propriate share  of  the  prepayment  dollar;  a greater 
return  to  the  public  in  benefits  provided;  and 
predictability  of  medical  charges  to  the  consumer. 

AMA  PresidenI-; 

End  Physician  Shortage 

The  physieian  shortage  can  “in  large  measure” 
be  solved  through  a major  overhaul  in  methods  of 
training  doctors,  according  to  the  new  president  of 
the  American  Medical  Association  and  member  of 
Illinois  Blue  Shield’s  Board  of  Trustees  since  1953. 
In  his  inaugural  address.  Dr.  Walter  C.  Bornemeier 
called  for  new  ways  of  training  doctors,  including 
the  use  of  physicians  in  private  practice  as  teachers. 
Dr.  Bornemeier  said  at  least  50,000  physicians  in- 
volved in  teaching,  too-lengthy  residency  programs, 
and  research  could  be  more  valuably  related  to 
patient  care.  This  diversion  of  doctors  “has  aggra- 
vated the  current  shortage  of  medical  services  for 
the  public,”  he  said. 


(This  is  not  an  advertisement) 


ASK  BLUE  SHIELD 

• . . ABOUT  MEDICARE 

EKG's  in 

Independent  Laboratories 

The  Social  Security  Administration  has  revised 
Medicare  regulations  and  now  permits  reimburse- 
ment to  be  made  for  taking  an  EKG  tracing  in  an 
approved  independent  laboratory.  Former  regula- 
tions required  that  the  tracing  be  taken  under  the 
direct  supervision  of  a physician.  Now,  payment 
can  be  made  as  long  as  the  individual  performing 
the  tracing  meets  the  requirements  of  a physician, 
laboratory  technologist  or  technician. 

No  change  has  been  made  in  the  regulations 
governing  the  approved  reading  and  interpreta- 
tion of  the  EKG.  This  still  must  be  performed  by 
a physician. 

If  the  laboratory  charge  includes  not  only  the 
taking  of  the  EKG  but  also  its  reading  and  inter- 
pretation by  a physician,  that  physician  needs  only 
to  be  identified  on  the  bill  or  the  SSA-1490.  In  fact, 
no  claim  for  a separate  physician’s  charge  will  be 
reimbursed  unless  it  is  that  of  the  attending  phy- 
sician or  a consultant.  This  provision,  too,  is  qual- 
ified in  that  reimbursement  will  be  made  for  this 
charge  if  “it  is  the  normal  practice  to  make  extra 
charges  for  this  service,  over  and  above  the  regular 
office  visit  charge.” 

When  submitting  a Medicare  claim  for  payment, 
it  is  necessary  to  supply  the  following  specific  in- 
formation: 

1.  Indicate  the  name  and  address  of  the  refer- 
ring physician. 

2.  In  an  emergency  situation,  “i.e.,  where  the 
patient  is  or  may  be  experiencing  what  is 
commonly  referred  to  as  a heart  attack,” 
please  furnish  evidence  that  the  physician 
was  in  attendance  at  the  time  the  service 
was  performed  or  that  he  was  present  im- 
mediately after  the  service  was  completed. 
In  this  situation  the  presence  of  a physician 
is  required. 

3.  In  a non-emergency  situation,  include  a des- 
cription which  will  clearly  indicate  that  the 
EKG  was  ordered  for  a covered  diagnosis, 
and  was  not  part  of  a routine  physical  ex- 
amination. 

4.  If  the  EKG  tracing  is  taken  in  the  Medicare 
beneficiary’s  home,  and  the  charge  for  the 
service  is  higher  than  it  would  be  if  the 
same  service  had  been  performed  in  the 
laboratory,  please  attach  a statement  describ- 


ing the  medical  necessity  for  performing  the 
service  outside  the  laboratory.  If  this  is  not 
done,  or  it  is  not  medically  necessary  to  per- 
form it  in  the  home,  payment  will  be  made 
according  to  the  reasonable  charge  for  per- 
forming the  service  in  the  laboratory. 

Before  a claim  can  be  considered  for  payment, 
the  physician  must  provide  the  laboratory  with  a 
written  referral  or  order  for  the  EKG’s  according 
to  Medicare  regulations.  The  order  should  contain 
all  the  information  listed  above  as  necessary  on  a 
claim.  Also,  the  laboratory  records  must  indicate 
the  name  of  the  individual  who  actually  performed 
the  EKG. 

By  observing  these  regulations  Illinois  Blue 
Shield,  as  Part  “B”  carrier  in  the  counties  of 
Gook,  Kane,  Lake,  DuPage  and  Will,  will  be  able 
to  prevent  delays  in  processing. 

Limitations  on  Injections 

Medicare  will  allow  payments  for  injections 
which  are  considered  a specific  or  effective  treat- 
ment for  a specific  condition  or  diagnosis.  In- 
jections given  for  the  “general  good  and  welfare 
of  the  patient”  are  not  considered  a covered  serv- 
ice according  to  Medicare  regulations. 

Vitamin  B-12  and  Endrate  are  two  injections 
which  have  caused  some  confusion.  The  Social 
Security  Administration  has  now  determined  spe- 
cific conditions  and  diagnosis  for  which  these  are 
considered  a covered  injection. 

Vitamin  B-12  is  considered  a specific  therapy  for: 
Certain  anemias:  pernicious  anemia;  megalo- 
blastic anemias;  macrocytic  anemias;  fish 
tapeworm  anemia. 

Certain  gastrointestinal  disorders:  gastrec- 
tomy; malabsorption  syndromes  such  as  sprue 
and  idiopathic  steatorrhea;  surgical  and  me- 
chanical disorders  such  as  resection  of  the 
small  intestine,  strictures,  anastomoses  and 
blind  loop  syndrome. 

Certain  neuropathies:  posterolateral  sclerosis; 
other  neuropathies  associated  with  pernicious 
anemia;  during  the  acute  phase  or  acute 
exacerbation  of  the  following — multiple  scle- 
rosis, trigeminal  and  glossopharyngeal  neu- 
ralgia, neuropathies  of  malnutrition  and  alco- 
holism, tabes  dorsalis,  causalgia,  postsympath- 
ectomy parasthesias,  diabetic  neuropathies  and 
herpes  zoster  and  other  inflammatory  neuri- 
tides  not  due  to  mechanical  or  traumatic  etio- 
logy. 

Endrate  is  considered  a covered  injection  when 
administered  to  selected  patients  for  the  emergency 
treatment  of  hypercalcemia  and  for  the  control  of 
ventricular  arrhythmias  and  heart  block  associated 
with  digitalis  toxicity.  It  may  be  indicated  in  pre- 
paration of  hypercalcemic  patients  for  emergency 
surgical  procedures  and  for  temporary  symptomatic 
treatment  of  patients  with  scleroderma. 


fThis  is  not  an  advertisement) 


Extension 


index 
.^SSminislra- 
^ tv  relieve 

' atatti  a 
reducing 
the 


^ef amble., 
mlloivs  a 
Jf^  titggesiiim  oj 
' to  dose 

mibtn  Ireat- 
iption  Jor 
mg^^tMets  will 
Iwe  a Jew 


TROCINATE 

Brand  THIPHENAMIL  HCl 

400  mg./lOO  mg.  S/C  tablets 

Trocinate  relaxes  all  smooth  muscles.  Its  direct  action  (muscu- 
lotropic)  does  not  involve  the  autonomic  nervous  system  and  it  is 
not  mydriatic.  It  is  metabolized  by  the  body  and  eliminated  in  the 
urine  as  harmless  degradation  products.  Trocinate  has  a remark- 
able history  of  freedom  from  side-effects. 

When  a pure  direct-acting  smooth  muscle  relaxant  is  indicated, 
Trocinate  is  the  drug  of  choice. 

DIARRHEA  (functional)  . . . the  first  400  mg. 
tablet  usually  relieves  the  di.scomfort  of  diarrhea  so 
promptly  that  it  ceases  to  be  a bother. 
DIVERTICULITIS— MUCOUS  COLITIS 
. . . the  accompanying  discomforts  can  be  relieved  by 
this  direct  smooth  muscle  relaxant. 

BLADDER  SPASM  . . . relaxation  is  immediate. 
One  or  two  tablets  condition  the  bladder  Jor  cystoscopy 
in  one  hour. 

SPASTIC  URETER  . . , the  specific  relaxing  effect 
of  Trocinate  on  the  spastic  ureter  has  been  proven  by 
animal  studies  and  affirmed  clinically.  {J.  Urol. 
73:487-93) 

PRESCRIBING  INFORMATION 

WARNING:  Do  not  give  in  advanced  kidney  or  liver  disease. 
PRECAUTIONS:  Trocinate  relaxes  all  smooth  muscles.  Large 
dosage  or  prolonged  usage  may  cause  feeling  of  weakness  or  can 
theoretically  precipitate  gall-bladder  colic,  due  to  relaxing  the 
vascular  and  duct  systems.  Caution  should  be  observed  in  patients 
with  urinary  bladder  obstruction.  DOSAGE:  400  mg.  May  be 
repeated  in  4 hours.  After  relief,  lengthen  the  dose  frequency, 
(see  side  note) 


WILLIAM  P.  POYTHRESS  & CO.,  INC. 

RICHMOND,  VIRGINI.A  23217 
3Tf/(r //t/yaerme'U  2^4^  i //iac€ueSc(r&. 


J.  Ernest  Breed 


The 

President’s 

Page 


ISMS  receives  praise  on  public  health  programs 


At  the  1970,  ISMS  convention,  onr  mem- 
bers were  congratulated  lor  their  contribu- 
tion to  public  health  programs  in  Illinois 
Iry  Dr.  Franklin  D.  Yoder,  director  of  the 
Department  of  Public  Health. 

Dr.  Yoder  told  our  House  of  Delegates 
he  took  special  pleasure  in  commending 
Illinois  doctors  at  a time  when  criticism  of 
the  medical  profession  seems  all  too  com- 
mon. His  remarks  specifically  mentioned 
physicians’  cooperation  in  the  state’s  im- 
munization campaign  against  German 
measles  that  has  made  this  program  one 
of  the  most  successful  in  the  country. 

The  Illinois  Department  of  Public 
Health  had  recpiested  the  cooperation  of 
our  members  in  countywide  immunization 
programs  because  of  the  alarming  increase 
of  birth  defects  due  to  German  measles. 

“The  response  (from  ISMS  members) 
was  nothing  short  of  remarkable,’’  Dr. 
Yoder  told  us.  He  said,  thus  far  600,000 
children  in  69  counties  have  been  inocu- 
lated and  the  remaining  counties  wordcl  be 
covered  by  the  beginning  of  the  new 
school  year. 

Dr.  Yoder  said  that  by  reaching  600,000 
children  at  such  an  early  date,  Illinois 
ranked  second  highest  in  the  country  in 
terms  of  rubella  protection. 

The  praise  given  to  ISMS  members  by 
Dr.  Yoder  is  well-earned.  According  to  a 
recently  conducted  ISMS  survey  of  county 
medical  societies,  nearly  2,550  physicians 
DONATED  more  than  12,500  free  man- 
hours of  time,  worth  an  estimated  $660,000 


to  jmblic  health  programs  during  the  past 
year. 

More  than  800,000  children  in  all  areas 
of  the  state  benefited  from  free  inocula- 
tions or  screening  programs  during  the  12- 
month  period  ending  May  1.  The  inocula- 
tion programs  heljred  protect  children  from 
rubella,  measles,  diphtheria,  smallpox  and 
polio.  Screening  projects  included  pre- 
school visual  exams,  hearing  and  vision 
tests,  physical  examinations,  and  tubercu- 
losis and  diabetes  testing. 

These  statistics  are  very  conservative 
liecause  less  than  25%  of  the  state’s 
county  societies  responded  to  the  survey. 
Since  most  county  societies  participate  in 
puirlic  health  programs,  a more  complete 
response  would  show  far  gieater  coopera- 
tion and  higher  statistics. 

The  ISMS  survey  was  conducted  to  help 
discredit  the  many  recent  charges  in  the 
national  press  and  television  networks 
criticizing  physicians  and  present  forms  of 
health  delivery.  Our  survey  results  certainly 
disprove  charges  that  physicians  are  no 
longer  coucerned  about  their  patients  . . . 
just  the  size  of  tlieir  bank  accounts. 

I am  proud  to  be  a member  of  this  medi- 
cal society  whose  concern  for  peojDle  is  more 
titan  an  idle  boast  and  is  backed  up  with 
statistics  such  as  these. 


116 


Illinois  Medical  Journal 


Cluiics  for  Crippled  Children  Scheduled 


I’wenty-seven  clinics  for  Illinois’  physi- 
cally handicapped  children  have  been 
scheduled  lor  September  by  the  University 
of  Illinois,  Division  of  Services  for  Crippled 
Children.  The  Division  will  hold  22  general 
clinics  providing  diagnostic  orthopedic, 
pediatric,  speech  ami  hearing  examinations 
along  with  medical,  social,  and  nursing  serv- 
ice. There  will  be  three  special  clinics  for 
children  with  cardiac  conditions  and  rheu- 
matic fever,  and  two  for  children  with 
cerebral  palsy.  Clinicians  are  selected  from 
among  private  physicians  who  are  certified 
Board  members.  Any  private  physician  may 
refer  or  bring  to  a convenient  clinic  any 
child  or  children  for  whom  he  may  want 
examination  or  consultative  services. 
September  1— Alton— Alton  Memorial 
Hospital 

September  2— Carnii— C a r m i Township 
Hospital 

September  2— Hinsdale— Hinsdale  Sani- 
tarium 

September  2— Rock  Island  Cerebral  Palsy 
—3808  Eighth  Avenue 
September  3— Sterling— Community  Gen- 
eral Hospital 

September  3— Effingham— St.  Anthony  Me- 
morial Hospital 

September  8— Peoria— St.  E r a n c i s Chil- 
dren’s Hospital 

September  8— East  St.  Louis— Christian 
Welfare  Elospital 

September  9— Champaign-Urbana  — Mc- 
Kinley Hospital 

.September  9— Joliet— St.  Joseph’s  Hospital 
September  10— Springfield  G e n e r a 1— St. 
John’s  Hospital 

September  10— Anna— Union  County  Hos- 
pital 

September  10— Macomb— McDonough  Dis- 
trict Hospital 

September  11— Chicago  Heights  Cardiac— 
St.  James  Hospital 


September  15— Rock  Island  Area  General— 
Moline  Pul)lic  Hospital 
.Se]:)tember  16— Evergreen  Park— Little  Com- 
pany of  Mary  Hospital 
September  16— Jacksonville— Norris  Hospi- 
tal 

September  1 7— Rockford— Rockford  Me- 

morial Hospital 

September  1 7— Decatur— Decatur  Memorial 
Hospital 

September  17— Elmhurst  Cardiac— Memori- 
al Hospital  of  DuPage  County 
September  22— Peoria— St.  E r a n c i s Chil- 
dren’s Hospital 

September  22— B cT  1 e v i 1 1 e— St.  Eliza- 
beth’s  Hospital 

September  23— Centralia— St.  Mary’s  Hospi- 
tal 

Sejnember  23— Elgin— .Sherman  Hospital 
September  23— Springfield  Pediatric  Neu- 
rology-Diocesan Center 
Se]3tember  21— DuQnoin— Marshall-Brown- 
ing Hospital 

September  25— Chicago  Heights  Cardiac— 
St.  James  Hospital 

The  Division  of  Services  for  Crippled 
Children  is  the  olficial  state  agency  estab- 
lished to  provide  medical,  surgical,  correc- 
tive, and  other  services  and  facilities  for 
diagnosis,  hospitalization  and  after-care  for 
children  with  crip|)ling  conditions  or  who 
are  sulfering  from  conditions  that  may  lead 
to  crippling. 

In  carrying  on  its  program,  the  Division 
works  cooperatively  with  local  medical  so- 
cieties, hospitals,  the  Illinois  Children’s 
Hospital-School,  civic  and  fraternal  clubs, 
visiting  nurse  association,  local  social  and 
^velfare  agencies,  local  chapters  of  the  Na- 
tional Eonndation  and  other  interested 
groups.  In  all  cases,  the  work  of  the  Divi- 
sion is  intended  to  extend  and  supplement, 
not  supplant  activities  of  other  agencies, 
either  public  or  private,  state  or  local,  car- 
ried on  in  behalf  of  crijjpled  children. 


A Common  Need  for  All  of  Us 

"Concentrations  of  populations,  outmoded  facilities,  and  the  concentration 
of  many  pollutants  pose  a threat  to  many  communities  across  the  nation. 
All  of  us  share  a common  need  for  air  and  water  and  their  many  uses. 
All  of  us  have  a stake  in  bringing  about  sound  management  of  these 
vital  resources."— Arch  N.  Booth,  executive  vice  president.  Chamber  of 
Commerce  of  the  United  States. 


for  August,  1970 


119 


Illinois  Medical  Journal 


volume  138,  number  2 


August,  1970 


Wily  does  asthma  occur 

at  night? 


By  Donald  L.  Unger,  M.D./Des  Plaines 


“Of  all  the  circiimstajices  attending  the 
commencement  of  an  asthmatic  paroxysm, 
none  is  more  constant  than  the  time  at 
which  it  occurs.  This  is  almost  invariably 
in  the  early  morning,  fro77i  two  to  six 
o’clock.” 

Since  Salter^  wrote  these  words  in  1882, 
there  have  been  several  explanations  for 
this  timing;  my  purpose  is  to  review  them. 
While  Salter  believed  that  the  horizontal 
position  was  a cause  of  nocturnal  asthma, 
he  still  described  a night  porter  who  slept 
all  day  and  yet  had  his  asthma  at  night. 
The  horizontal  position  leads  to  accumula- 
tion of  bronchial  secretions  and  embarrasses 
respiration  because  of  pressure  of  the  ab- 
dominal organs  against  the  diaphragm. ^ It 
also  causes  a passive  decrease  in  bronchial 
diameter.3  Since  almost  all  asthmatics  sit  up 


Donald  L.  Unger,  M.D.,  is 
engaged  in  private  practice  as 
an  allergist  and  is  presently 
chief  of  the  Allergy  Service  at 
Loyola  University  S t r i t c h 
School  of  Medicine.  He  re- 
ceived his  M.D.  degree  from 
Northwestern  and  is  past 
president  of  the  Chicago  So- 
ciety of  Allergy.  He  is  cred- 
ited with  numerous  articles  in 
his  field  of  allergy. 


during  attacks,  it  is  obvious  that  lying  flat 
makes  them  worse. 

The  importance  of  prolonged  exposures 
during  sleep  has  also  been  emphasized,^  as 
the  average  person  spends  about  one-third 
of  his  life  in  his  bedroom.  Allergens  there 
w^ould  favor  the  development  of  attacks, 
even  though  sensitivities  to  them  might  be 
slight.  Because  feathers  are  usually  a minor 
allergen,  it  may  take  a long  time  for  them 
to  cause  symptoms,  but  sleeping  several 
hours  on  a feather  pillow  may  cause  symp- 
toms. Nocturnal  asthma  suggests  sensitivity 
to  feathers  and  mattresses,^  and  mattresses 
are  the  prime  source  of  allergenic  dusts. 
Asthma  also  predominates  at  night,  how- 
ever, in  patients  sensitive  to  pollens  and 
foods. ^ 

Ground  level  pollen  counts  are  higher  at 
night  than  during  the  day.  Using  an  air- 
plane, Heise®"'^  did  a series  of  pollen  and 
mold  counts  at  various  locations,  altitudes 
and  times  of  the  day.  He  described  an  easily 
visible  cloud  layer  containing  maximum 
concentrations  of  allergenic  particles.  This 
cloud  rises  from  early  afternoon  until  about 
eight  at  night,  and  then  slowly  falls  until 
dawn  when  there  is  ground  fog.  These 
studies  were  done  during  the  late  summer 
when  hot  air  rising  carried  particles  up- 


for  August,  1970 


123 


wards  during  the  day,  the  cloud  lowering 
at  night  as  the  gi'ound  cooled.  This  may 
explain  why  pollenosis  is  worse  in  the  early 
morning.  Since  air  pollutants  are  present 
in  this  cloud,  patients  not  sensitive  to  pol- 
letis  and  molds  should  also  be  worse  about 
dawn.  No  such  studies  were  done  during 
tlie  winter  months  to  determine  if  a similar 
pattern  is  present. 

Circadian  rhythms  in  body  functions  also 
lelate  to  nocturnal  asthma.  For  example, 
vital  capacity  and  forced  expiratory  volume 
are  normally  lower  at  night,®  and  this  is 
much  more  pronounced  in  asthmatics.^ 
Smaller  amounts  of  histamine  are  needed 
to  lower  these  tests  at  night,  this  apparently 
being  a fundamental  feature  of  asthmatic 
and  bronchitic  patients. 

With  diurnal  variations  in  steroid  levels, 
attacks  of  asthma  occur  mainly  when 
adrenal  activity  is  at  its  trough. Plasma 
1 7-hydroxycortico-steroid  levels  fall  during 
sleep,  reaching  a nadir  between  two  and 
four  in  the  morning. Reversing  the  times 
of  sleep  and  activity  reverses  this  circadian 
cycle,  but  the  response  is  independent  of 
position  and  light. 

In  summary,  the  causes  of  nocturnal 
asthma  can  be  divided  into  those  from 
outside  the  body  and  those  from  within. 
External  factors  include  increased  exposures 
to  bedroom  antigens,  pollens,  molds  and 
air  pollutants.  Internal  changes  are  de- 
creased pulmonary  function  and  levels  of 
adrenal  hormones,  and  increased  sensitivity 
to  histamine.  The  horizontal  position  causes 
narrowing  of  the  bronchial  tree,  accumula- 


tion of  secretions  and  pressure  of  the  ab- 
dominal contents  against  the  diaphragm. 
Many  factors  increase  asthma  at  night  and 
these  vary  from  person  to  person,  season 
to  season,  and  expose  the  exposure.  M 

References 

1.  Salter,  H.  H,:  Asthma:  Its  Pathology  and 
Treatment,  1st  American  Ed.,  New  York,  Wil- 
liam Wood  & Co.,  1882,  page  33. 

2.  Coca,  F.;  Walzer,  M.;  and  Thommen,  A.  A.: 
.Asthma  and  Hay  Fever  in  Theory  and  Prac- 
tice. Springfield,  111.,  Charles  C Thomas,  1931, 
pages  212-213. 

— S.  Bouhuys,  A,:  “Experimental  .Asthma:  Postural 
Effects,"  Amer.  J.  Med.,  34:470,  1963. 

4.  Vaughn.  W.  T.:  Practice  of  .Allergy.  St. 

Louis.  C.  V.  Mosby  Co.  1939,  page  138. 

5.  Feinberg,  S.  M.:  .Allergy  in  Practice.  Chicago. 
A'ear  Book  Publishers.  Inc.,  1946,  page  401. 

6.  Heise,  H.  A.  and  Heise,  E.  R.:  “nistribution 
of  Ragweed  Pollen  and  Alternaria  Spores  in 
tipper  Atmosphere,  ].  Allerg)',  19:403,  (Nov), 
1948. 

7.  Heise,  H.  ,A.  and  Heise,  E.  R.:  “Effect  of  a City 
on  Fall-out  of  Pollens  and  Molds,’’  J.A.M.A., 
163:803,  (March  9),  1957. 

8.  Menzel,  W.:  “Krankheit  und  Biologische  Rhv- 
thmen,’’  Arzt.  Mitteihmgen-Deutsches  arztebl., 
41:1201,  1958. 

9.  Israels,  ,\.  A.:  “Asthma  Bronchiale,  etterige 
(bacteriele  bronchitis)  en  bet  Endocriene  Sys- 
teem."  (Thesis)  Groningen,  1951. 

"^lO.  F)“A'ries,  K.,  Goei,  J.  T.,  Booy-Noord,  H,  and 
Orie,  N G.M.:  “Changes  During  24  hours  in  the 
Lung  Function  and  Histamine  Reactivity  of 
the  Bronchial  Tree  in  .Asthmatic  and  Bronchi- 
tic Patients,’’  Int.  Arch.  AIL.  (Basel)  20:93, 
1962. 

11.  Reed,  C.  F..:  .Allergology.  .Amsterdam.  Ex- 
cerpta  Medica  Foundation.  1968,  page  411. 

12.  Reinberg,  .A.,  Ghata,  J.,  and  Sidi,  E.:  “Noc- 
turnal .Asthma  Attacks:  Their  Relationship  to 
the  Circadian  Adrenal  Cycle,”  /.  .411.,  34:323, 
( Iiilv-.Aug.),  1963 

13.  Nichols,  C.  T.  and  Tyler,  F.  H.:  “Diurnal 
A'ariation  in  Adrenal  Cortical  Function.”  Am. 
Rev.  Med.,  18:313,  1967. 


Obituaries 


*Leroy  Fatherree,  Urbana,  died  June  15 
at  the  age  of  69.  He  served  as  state  director 
of  the  Illinois  Department  of  Public 
Health. 

^Chester  Coggeshall,  Chicago,  died  June 
2 at  the  age  of  61.  He  was  founder  of  the 
Chicago  Diabetes  Association. 

*Earl  W.  Canid  well,  Lemont,  died  May 
16  at  the  age  of  87.  He  was  a member  of 
the  ISM.S  Fifty  Year  Club. 

* Rudolph  A.  Schaefer,  Plano,  died  Febru- 
ary 2 at  the  age  of  91.  He  was  a member 
of  the  ISMS  Fifty  Year  Club. 

*Loring  S.  Helfrich,  Moline,  died  Janu- 
ary 16  at  the  age  of  59.  He  was  a past  presi- 
dent of  the  Rock  Island  County  Medical 
•Society. 


-Arthur  T.  G.  Remmert,  Chicago,  died 
February  14  at  the  age  of  72. 

*Edwiii  S.  Braden,  Jr.,  Northbrook,  died 
January  18  at  the  age  of  51. 

* Margaret  M.  Knnde,  Chicago  Heights, 
died  June  30  at  the  age  of  82. 

*Channcey  C.  Maher,  Chicago,  died  at  the 
age  of  72.  He  was  a former  director  and 
chairman  of  Scientific  Exhibits  lor  the  IS- 
MS annual  meetinas. 

Alva  A.  Knight,  Chicago,  died  June  22  at 
the  age  of  81. 

Anton  J.  Vlcek,  LaGrange,  died  July  4 at 
the  age  of  54. 

* Henry  W,  Hilsten,  Chicago,  died  July  3 
at  the  age  of  70. 

*lndicales  member  of  Illinois  State  Medical  Society 


121 


Illinoi.s  .Medical  Journal 


X.  d ^ '> 


r“ 

Surgical  Grand  Rounds  are  held  weekly  on  Saturday  at 
8:00  a.rn.  in  Offield  Auditorium  at  Passavant  Memorial 
Hospital.  Patient  presentations  from  Chicago  Wesley  Me- 
morial, Passavant  Memorial,  and  the  Veterans  Administra- 
tion Research  Hospitals  form  the  basis  of  the  discussions. 
This  case  report  zuas  part  of  the  Surgical  Grand  Rounds 
on  March  21,  1970. 


Intermittent 

Jaundice 


Edited  by  John  M.  Beat,  M.D. 


Case  Report: 

Dr.  John  S.  Williams:  A 75-year-old, 
white,  male  was  admitted  to  the  Veterans 
Administration  Research  Hospital  on 
February  16,  1970,  with  abdominal  pain 
of  two  days’  duration.  After  eating  fried 
chicken  for  dinner  two  days  prior  to  ad- 
mission, he  developed  constant  midepigas- 
tric,  and  diffuse  upper  abdominal  pain  ap- 
proximately two  hours  later.  The  pain  kept 
him  awake  but  he  did  not  have  nausea, 
vomiting  or  diarrhea.  He  had  not  had  simi- 
lar pain  prior  to  this  episode.  He  denied 
fever  or  chills.  Because  the  pain  persisted, 
he  came  to  the  V.A.  Research  Hospital. 
Soon  after  the  onset  of  pain,  he  noticed  that 
his  urine  was  darker  than  normal. 

Past  history:  eight  years  prior  to  admis- 
sion a suprapubic  prostatectomy  had  been 
performed  for  benign  prostatic  hypertrophy. 

Physical  examination;  the  patient  was 
well-nourished  and  was  not  in  acute  dis- 
tress. Pulse,  blood  pressure,  and  tempera- 
ture were  normal.  The  sclera  were  mildly 
icteric.  Chest  and  heart  were  unremarkable. 


Abdominal  tenderness  was  absent  and  good 
bowel  sounds  were  present.  Rigidity  and 
voluntary  guarding  were  not  present. 

Admission  blood  counts  and  urinalysis 
were  unremarkable.  Two  days  after  admis- 
sion, after  eating  tuna  fish,  he  again  de- 
veloped acute  right  upper  quadrant  pain, 
without  nausea,  vomiting,  chills  or  fever. 
Examination  revealed  tenderness  in  the 
right  upper  quadrant. 

Multiple  laboratory  determinations  were 
obtained.  Admission  values  included  serum 
bilirubin  of  4.9  mgm.%,  alkaline  phospha- 
tase, 49  units,  and  serum  amylase  of  560 
units.  Amylase  values  were  within  normal 
limits  within  24  hours  but  bilirubin  levels 
varied  from  2.8  to  7 mgm.%.  SCOT  was 
50  units.  An  oral  cholecystogram  was  ob- 
tained before  jaundice  was  detected.  A per- 
cutaneous cholangiogram  was  performed 
preoperatively. 

Dr.  Abram  Cannon:  A very  faint  visuali- 
zation of  the  gall  bladder  is  seen  after  oral 
administration  of  the  contrast  material.  As 
nearly  as  I can  tell  in  this  faintly  outlined 


126 


Illinois  Medical  Journal 


Fig.  1.  Percutaneous  cholangiograni  elemonstrated 
tapered  end,  which  suggested  neoplasm. 


gall  bladder,  there  are  no  stones.  There  is 
a small  diverticulum  of  the  upper  esopha- 
gus. The  stomach  and  colon  is  normal. 

In  the  presence  of  jaundice,  the  poor 
visualization  of  the  gall  bladder  is  prob- 
ably due  to  decreased  excretion  of  contrast 
material.  Without  seeing  stones,  I don’t 
think  the  gall  bladder  can  be  called 
abnormal. 

The  percutaneous  cholangiogram  shows 
good  filling  of  the  common  duct.  There  is 
some  extravasation  of  the  contrast  material 
about  the  bed  of  the  liver,  but  there  is 
good  visualization  of  the  common  duct. 
The  duct  is  obstructed.  The  caliber  is  great- 
er than  usual  and  there  is  a tapering  distal 
end  to  the  common  duct  (Fig.  1).  Usually, 
with  a stone,  there  will  be  a rather  abrupt 
termination  of  the  duct  without  the  taper- 
ing that  is  seen  in  this  patient.  The  prob- 
ability of  a tumor  about  the  distal  end  of 
the  duct  is  great,  although  the  duct  itself 
is  not  irregular. 

Dr.  Robert  Glass:  The  percutaneous  chol- 
angiogram was  performed  immediately  be- 
fore operation  and  was  helpful.  At  the  time 
of  operation  the  gall  bladder  was  found  to 
be  slightly  thickened  but  without  stones. 
Stones  were  not  present  in  the  common 
duct,  which  was  perhaps  11  or  12  mm.  in 
diameter.  Stones  were  not  found  in  the 
intrapancreatic  portion  of  the  duct.  There 
was  a 4 cm.  diameter  mass  in  the  head  of 
the  pancreas.  With  the  results  of  the  per- 
cutaneous cholangiogram,  with  the  absence 
of  stones,  in  a 75-year-old  patient  with  a 
mass  in  the  head  of  the  pancreas,  Roux-en- 
Y cholecystojejunostomy  was  selected.  The 
patient  has  done  well  and  his  jaundice  is 
diminishing. 


obstruction  of  the  common  bile  duct  with  a 

Percutaneous  cholangiography  had  its 
origin  in  1920,  when  Burkhardt  and  Muel- 
ler, in  Germany,  injected  the  gall  bladder 
through  a percutaneous  approach  and  visu- 
alized the  extrahepatic  biliary  tree.  In 
1924,  Graham  and  Cole  injected  tetra- 
bromophenopthalein  intravenously  and  vis- 
ualized the  gall  bladder  and  biliary  tree. 
A year  later,  the  oral  cholecystogram  was 
demonstrated  by  them.  Graham  and  asso- 
ciates wrote  a book  in  1928,  Diseases  of 
THE  Liver  and  Biliary  Tract,  in  which 
Burkhardt  and  Mueller’s  work  was  men- 
tioned only  to  condemn  it.  In  1937,  per- 
cutaneous transhepatic  injection  of  the 
biliary  tree  was  first  done  by  Huard  and 
Do-Xuan-Hop.  In  the  United  States  in  1952, 
Carter  and  Saypol  reported  transhepatic 
injection  of  radiopaque  material.  In  1962, 
Glenn  reported  percutaneous  cholangio- 
graphy in  46  patients.  Glenn  stated  that  the 
procedure  was  useful  in  jaundice  of  uncer- 
tain etiology  and  that  extrahepatic  obstruc- 
tion could  be  differentiated  from  jaundice 
caused  by  parenchymal  disease.  In  46  pa- 
tients, he  was  able  to  visualize  the  extra- 
hepatic biliary  tree  in  32,  or  70%.  In  ten  of 
the  remaining  14,  intrahepatic  causes  of 
jaundice  were  found  ultimately. 

Beal  reported  a series  of  cases  in  1965, 
and  reviewed  the  literature.  In  his  experi- 
ence, failure  to  visualize  the  extrahepatic 
tree  with  percutaneous  cholangiography  in- 
dicated a 75%  probability  that  extrahepatic 
obstruction  was  not  present. 

The  procedure  is  relatively  safe.  There 
are  two  major  complications:  bile  leakage 
and  hemorrhage.  Both  complications  can 
be  managed  by  subjecting  the  patient  to 
operation  when  the  percutaneous  cholan- 


for  August,  1970 


127 


giogiam  has  been  performed  and  obstruc- 
tion of  the  biliary  tree  has  been  demon- 
strated. 

Dr.  James  Apostol:  This  patient  illustrates 
the  advantages  of  percutaneous  cholangio- 
graphy. The  problem  in  this  patient  was 
that  his  work-up  indicated  he  had  a com- 
mon duct  stone.  He  had  a fluctuating  bili- 
rubin level.  Initially,  a gall  bladder  series 
was  ordered  and  obtained  without  realizing 
that  his  bilirubin  was  already  3.5  mgm.% 
and  the  gall  bladder  did  faintly  visualize. 
There  was  mild  right  upper  quadrant 
pain,  but  no  signs  of  infection,  and  the 
gall  bladder  was  not  palpable.  We  were 
certain  that  he  would  have  a common  duct 
stone.  Imagine  our  surprise  when  the  per- 
cutaneous cholangiogram  revealed  evidence 
consistent  with  malignancy. 

A further  interesting  point  is  that  he  had 
early  obstruction.  At  the  time  of  surgery, 
the  gall  bladder  was  not  distended  and 
the  common  duct  was  not  appreciably 
enlarged.  Therefore,  it  should  have  been 
difficidt  to  perform  a percutaneous  cholan- 
giogram on  this  patient.  Dr.  Lorenzo  should 
make  a few  comments  about  his  experience 
to  insure  success  whth  this  technique. 

The  final  point  is  that  at  the  time  of 
surgery  it  was  easy  for  us  to  very  quickly 
make  rqj  our  minds  that  this  must  be  a 
malignancy.  We  know'  that  if  we  had  tried 
to  make  a definite  pathological  diagnosis, 
we  would  be  unsuccessful  in  a significant 
percentage  of  cases,  assuming  that  he  does 
have  a carcinoma  of  the  head  of  the  pan- 
creas. Furthermore,  with  needle  biopsy  or 
with  duodenotomy  or  common  duct  ex- 
ploration, we  would  significantly  increase 
the  possibility  of  morbidity  and  mortality. 
Since  the  patient  is  75-years-old,  let  us  just 
accept  the  fact  that  the  findings  at  the  time 
of  surgery,  along  with  the  cholangiogram 
w'ere  consistent  with  a carcinoma  of  the 
head  of  the  pancreas. 

Dr.  Gabriel  Lorenzo:  Generally  speaking, 
percutaneous  cholangiography  is  not  a com- 
plicated procedure.  The  cholangiogram  is 
scheduled  to  be  followed  by  laparotomy 
unless  normal  biliary  ducts  are  found.  The 
procedure  is  performed  in  the  Radiology 
Department  with  the  patient  on  the  fluor- 
oscopy table  in  the  supine  position.  The 
skin  over  the  lower  chest  and  upper  ab- 
domen is  prepared  and  draped,  and  the 
skin  is  infiltrated  with  1%  xylocaine  in  the 
midclavicular  line,  approximately  2 to  3 


cm.  below  the  right  costal  margin.  A 6 inch, 
#18  gauge  needle  with  a teflon  catheter  is 
held  at  a 45°  angle  cephalad  and  directed 
20  to  25°  medially,  advanced  through  the 
abdominal  wall  and  into  the  liver  paren- 
chyma to  end  as  close  as  possible  in  the 
hilum.  The  position  of  the  needle  is  then 
confirmed  with  the  fluoroscope  using  the 
image  amplifier.  The  stylet  is  removed  and 
a 50cc.  syringe  containing  75%  Hypaque 
or  Renografin  is  attached  to  the  needle. 
No  attempt  is  made  to  aspirate  bile.  A 
small  amount  of  the  contrast  material,  0.5 
to  1 cc.,  is  injected  and  with  the  help  of 
the  image  amplifier  it  can  be  verified  if  the 
dye  is  entering  one  of  the  liver  radicals,  a 
vascular  structure  or  infiltrating  the  liver 
substance.  If  the  first  attempt  has  been  un- 
successful the  needle  is  withdrawn  1 cm. 
at  a time  each  time  until  a bile  duct  is 
visualized.  At  the  completion  of  the  pro- 
cedure and  before  the  needle  is  withdrawn 
I try  to  aspirate  as  much  bile  as  possible 
to  reduce  the  volume  of  fluid  in  the  biliary 
tree.  The  patient  is  then  taken  to  the 
operating  room  for  laparotomy  unless  a 
normal,  unobstructed  biliary  tract  is  found. 
Dr.  John  Beal:  Dr.  Rosi,  should  a pallia- 
tive procedure,  such  as  cholecystojejunos- 
tomy  be  performed  without  biopsy  of  the 
pancreas? 

Dr,  Peter  Rosi:  Palliative  procedures  such 
as  cholecystojejunostomy  should  be  per- 
formed upon  the  clinical  impression  ob- 
tained during  surgery  without  subjecting 
the  patient  to  a biopsy  of  the  pancreas 
which  has  certain  hazards,  such  as  pan- 
creatic fistula,  seeding  of  the  peritoneum 
with  malignant  cells  if  the  carcinoma  is  in- 
cised and  false  negative  biopsies.  Carci- 
nomas of  the  pancreas  are  often  associated 
with  a chronic  pancreatitis  which  makes  it 
difficult  to  outline  the  site  of  the  tumor. 
Biopsies  of  the  pancreas  under  these  con- 
ditions are  unreliable.  Adding  a pancreatic 
biopsy  to  a palliative  procedure  would  add 
unjustifiable  risks  to  these  often  aged 
patients. 

Dr,  Robert  Ryan:  Is  the  Rose  Bengal  test 
useful  in  patients  who  are  jaundiced? 

Dr.  Beal:  The  Rose  Bengal  and  the  other 
isotope  studies  are  helpful,  but  like  other 
tests,  including  the  percutaneous  cholan- 
giogram, they  have  certain  limitations.  The 
liver  scan  will  detect  defects  in  the  liver, 

(Continued  on  page  177) 


128 


Illinois  Medical  Journal 


THE  VIEW  BOX 


By  Leon  Love,  M.D. 

Director,  Department  of  Radiology,  Loyola  University  Hospital 
and  Chairman,  Department  of  Radiology,  Loyola  University 
Stritch  School  of  Medicine 


A 60-year-old  male  entered  the  hospital 
with  a chief  complaint  of  persistent  ab- 
dominal pain  of  several  days  duration.  Two 


Fig.  2 


years  earlier  he  had  undergone  ligation  of 
the  inferior  vena  cava  because  of  repeated 
episodes  of  pulmonary  emboli,  which  were 
not  controlled  by  adequate  anticoagulation 
therapy.  He  improved  after  surgery.  Spu- 
tum cidtures  obtained  during  this  admis- 
sion were  reported  positive  for  tuberculosis. 
He  was  placed  on  I.  N.  H.  At  no  time  was 
the  posterior  mediastinal  mass  noted  on 
radiographs  taken  up  to  six  months  before 
his  present  admission.  The  patient  was  a 
chronic  alcoholic  who  admittedly  drank 
about  a fifth  of  bourbon  daily.  On  admis- 
sion the  physical  exam  revealed  a vague 
fullness  and  slight  tenderness  in  the  upper 
gastrium  and  slight  edema  in  both  lower 
extremities.  An  upper  GI  examination  was 
tlone  followed  by  surgery.  What’s  your 
diagnosis? 

1.  Alimentary  tract  duplication 

2.  Lymph  node  enlargement  such  as 
lymphoma,  tuberculosis,  or  metastases 
with  displacement  of  the  paraverte- 
bral shadow 

3.  Dissecting  aneurysm  of  the  aorta 

4.  Collateral  venous  channels 

5.  Mediastinal  pancreatic  pseudocyst 

(Answer  071  page  177) 


Fig.  3 


for  August,  1970 


129 


ArgentafFine  Carcinoma 
(Carcinoid  tumor) 

Involving  the  ampulla  of  Vater 


Argentaffine  tumors  of  the  duodenum 
are  rare.  A review  published  in  1959  indi- 
cates that  only  2S  authenticated  cases  had 
been  reported  up  to  that  time.^  In  a series 
of  21  carcinoid  tumors  involving  the  gastro- 
intestinal tract,  07ily  three  were  located  in 
the  duodeyiiim Carcij7oids  originating  in 
or  iiivolving  the  ampulla  of  Vater  are  even 
more  rare  as  only  six  of  these  cases  have 
been  published  to  date,  to  the  best  of  our 
hnowledge.^'^  The  present  report  describes 
an  additional  case  of  argentaffine  carcinoma 
(carcinoid  tumor)  involving  the  ampulla 
of  J'ater. 


Mario  Stefanini,  M.D. 
(top),  is  a pathologist  and 
Director  of  Laboratories,  St. 
Elizabeth’s  Hospital,  Danville. 
He  is  a graduate  of  the  Medi- 
cal School,  University  of 
lioine  and  received  an  M.Sc. 
degree  from  Marquette  Uni- 
versity. Internship  and  resi- 
dency training  in  pathology 
and  hematology  were  taken  at 
■New  England  Center  Hospital, 
Boston.  Dr.  Stefanini  is  a Dip- 
'omate,  American  Board  of 
Pathology  and  an  editor  and 
author  of  texts  dealing  with 
his  field.  John  E.  lirbas,  M.D. 
''center),  received  his  M.D. 
’’rom  St.  Louis  University 
Medical  School  and  interned 
at  St.  John’s  Hospital,  St. 
^.ouis.  He  is  in  the  private 
Practice  of  medicine  with  spe- 
-ial  emphasis  on  general  sor- 
cery. Fred  L Crockett,  M.D. 
''bottom),  received  his  medi- 
"al  training  at  Meharrv  Me- 
'fieal  College  and  served  a ro- 
'ating  internship  at  Pontiac 
General  Hospital.  He  is  cur- 
"eptly  in  the  private  practice 
of  medicine. 


By  Mario  Stefanini,  M.D.,  John 
E.  Ureas,  M.D.,  and  Fred  L. 

Crockett,  M.D. /Danville 

Case  Report 

A 47-year-old  Afro-American  female  was 
admitted  with  chief  complaints  of  weak- 
ness and  of  jaundice  of  sclerae  of  three 
months  duration.  A previous  episode  six 
months  earlier  had  lasted  about  two  weeks. 
Physical  examination  confirmed  jaundice  of 
sclerae  and  visible  mucosae.  Liver  was  palp- 
able 4 lbs.  below  the  costal  margin.  LIrine 
was  dark  and  stool  clay-like.  A G-I  series 
was  described  as  indicating  “extrinsic”  pres- 
sure on  duodenal  bulb  and  descending  duo- 
denum. Gall  bladder  was  not  visualized,  but 
no  ojracjue  calculi  were  identified.  Urine 
was  positive  for  bile  and  negative  for  uro- 
bilinogen. RBC  count  was  3.23  M/cu.mm.; 
hemoglobin  6.1  gms.%;  hematocrit  18%; 
WdiC  count  8,100/cu.  mm.  with  1 stab 
form,  52  neutrophils,  two  eosinophils,  42 
lymphocytes  and  three  monocytes.  Six  per 
cent  normoblasts  were  counted.  Peripheral 
blood  smear  showed  severe  hypochromia, 
numerous  ortho-  and  poly-chromatophilic 
target  cells  and  increased  number  of  plate- 
lets. test  with  sodium  metabisulfite  was 
positive  for  appearance  of  sickle  tactoids. 
Red  cell  fragility  test  showed  values  of 
0.38%  and  0.30%  NaCl  for  initial  and 
coni])lete  hemolysis  (control:  0.42%  and 
0.34%,  respectively).  The  presence  of  sickle 
cells  and  the  decreased  red  cell  fragility 
were  confirmed  by  electroj)horesis  of  hemo- 
globin on  cellulose  acetate  paper,  which 
showed  a small  (9.4%)  component  of  hemo- 
globin S,  consistent  with  sickle  cell  trait. 

After  patient  had  been  on  a standard 
80  gms.  fat  diet  for  three  days,  stool  exami- 


130 


Ittinois  Medical  Journal 


Fig.  1 : Microscopic  field  of  tumor.  Note  solid  cords  of  cells  with  prominent  dark  nucleus  and 
finely  granular  cytoplasm,  separated  by  thick,  fibrous  septa. 


nation  with  Nile  blue  and  Sudan  III  stains 
revealed  moderately  increased  amount  oi 
neutral  fat  and  of  undigested  carltohy- 
drates.  Protein  determination  and  electro- 
phoresis of  serum  indicated  a total  protein 
of  7.4  gms.%  with  A/G  ratio  of  0.7  and 
elevation  of  ^ (24.2%)  and  y (27.6%)  frac- 
tions. Miscellaneous  tests  of  liver  function 
showed  elevation  of  serum  bilirubin  (16.2 
mgs.%  total  with  10.5  mgs.%  direct  react- 
ting),  and  alkaline  phosphatase  (27.9  Bes- 
sey-Lowry’s  units).  Cephalin  flocculation 
test  was  1-|-  in  24  hours.  Serum  GOT  and 
GPT  were  45  and  29  SIGMA  units,  re- 
spectively. Prothrombin  time  of  plasma  was 
21  seconds  (with  control  of  12.5  seconds) 
and  was  corrected  to  16.2  seconds  in  four 
hours  by  the  intravenous  administration  of 
70  mgs.  Hykinone.  Tests  of  pancreatic  func- 
tion included  a serum  lipase  of  1.1  Tietz 
units  (normal:  up  to  0.6)  and  serum  amy- 
lase of  205  Somogyi  units.  Serum  leucine 
aminopeptidase  was  120  Goldbarg-Ruten- 
berg  units  (normal  in  females:  80-120). 

Clinical  Diagnosis 

The  tentative  clinical  diagnosis  was  ob- 
structive jaundice  with  concomitant  pan- 
creatic disease  in  a patient  with  sickle  cell 
trait.  After  blood  transfusions  had  raised 
the  hemoglobin  level  to  12.5  gms.%,  the 
patient  was  brought  to  surgery.  Since  a 
spherical  mass  was  palpable  in  the  second 
portion  of  the  duodenum,  the  duodenum 
was  opened  by  anterior  approach,  to  reveal 


a mass  measuring  about  2 x 2.5  cm.  in  the 
area  of  the  ampulla  of  Vater.  After  biopsy, 
the  duodenum  was  closed,  and  a cholecysto- 
jcjunostomy  carried  out.  Following  surgery, 
there  was  a rapid  decrease  in  clinical  jaun- 
dice and  the  level  of  bilirubin  fell  within 
two  weeks  to  3.2  mgs.%  total  and  2.7 
mgs.%  direct  reacting.  A test  lor  5-OH- 
indol-acetic  acid  in  24-hour  urine  was  nega- 
tive. The  patient  left  the  hospital  asympto- 
matic and  has  experienced  no  recurrence 
of  symptoms  for  36  months  lollowing  sur- 
gery. A stool  study  on  a sample  obtained 
from  the  patient  on  an  unrestricted  diet  con- 
tinues to  show  moderate  increase  in  undi- 
gested carbohydrates  and  neutral  fat. 

Pathologic  Findings 

Biopsy  yielded  a portion  of  yellowish,  soft 
tissue  measuring  0.5  x 0.6  x 0.8  cm.  Sections 
showed  yellowisli  color  throughout  and  gave 
a positive  ferric  ferricyanide  reaction.  Mi- 
croscopic examination  indicated  that  the 
tissue  was  composed  of  solid  groups  of 
spheroidal  cells  with  large,  hyperchromatic 
nuclei  and  finely  granulated  cytoplasm,  sup- 
ported by  scanty  and  partly  sclerosing 
stroma.  (Fig.  1)  Glandular  patterns  were 
not  noted.  A positive  methenamine  silver 
impregnation  and  positive  ferric  ferricya- 
nide reaction  of  cells  were  obtained. 

Comments 

Intermittent  obstructive  jaundice  was  the 
presenting  symptom  in  our  patient,  as  in 


for  August,  1970 


131 


cases  previously  described.  Similarly,  there 
was  no  evidence  of  “carcinoid  syndrome” 
in  our  patient,  nor  could  5-OH-indol  acetic 
acid  be  found  in  the  urine. 

The  majority  of  carcinoid  tumors  located 
in  the  duodenum,  with  or  without  involve- 
ment of  the  ampulla  of  Vater,  have  been 
treated  surgically  with  wide  resection 
through  a transduodenal  approach  and  re- 
implantation of  the  common  duct  into  the 
duodenum;^  by  local  resection  of  the  tumor 
along  with  a cuff  of  normal  tissue;-'®  or 
with  pancreatico-duodenectomy.'’  " One  case 
treated  with  pancreatico-duodenectomy  ex- 
pired with  disseminated  metastases  within 
eight  months  of  the  surgical  procedure.' 
Other  cases  were  free  of  recurrence  foi 
periods  of  time  extending  from  21  months 
to  5.5  years,  in  agreement  with  the  known 
lack  of  agressiveness  of  these  tumors.  Oui 
patient,  who  underwent  a cholecystojeju- 
nostomy  for  the  relief  of  the  biliary  ob- 
struction, survives  36  months  later  and  is 
asymptomatic.  It  is  of  interest  that  no  evi- 
dence of  pancreatic  duct  obstruction  is 
clinically  evident.  Perhaps,  while  the  duo- 
denal end  of  Wirsung’s  duct  is  involved  in 
the  area  of  carcinoid  tumor,  the  accessory 
Santorinian  duct,  opening  into  the  duo- 
denum about  2.5  cm.  above  the  ampulla, 
remains  patent.  This  consideration  would 
explain  why  digestion  of  fats  and  of  carbo- 
hydrates was  originally  and  remains  rela- 
tively unimpaired. 


Summary 

The  report  discusses  an  exceedingly  rare 
case  of  argentaffine  carcinoma  (carcinoid 
tunror)  in  a 47-year-old  female  with  sickle 
cell  trait,  involving  the  ampulla  of  Vater 
and  presenting  as  obstructive  jaundice. 
Cholecystojejunostomy  was  followed  by 
clinical  recovery.  The  patient  is  alive  and 
apparently  well  36  months  after  the  ori- 
ginal surgical  procedure. 

Acknowledgements 

The  authors  express  their  appreciation 
to  Mrs.  Opal  I.  Deeken,  CLA  (ASCP),  and 
Mrs.  Dorothy  f.  Caldwell,  CLA  (ASCP)  for 
technical  assistance  in  the  determination  of 
the  biochemical  parameters  of  the  patient. 

References 

1.  McRae,  J.  M.  and  Conn,  J.  H,:  "Carcinoid  of 
ampulla  of  Vater”  Surgery,  46:902-907,  1959. 

2.  Mrazeck,  R,  G.,  Godwin,  M,  C.  and  Mohrardt, 
J,:  “Carcinoid  tumons:  clinical  and  pathologic 
study  of  27  cases.”  S.  G.  ir  O.,  96:661-673,  1953. 

3.  Brentano,  “Tumorver.schluss  des  Choledocus 
in  seinein  retroduodenal  Teil.  Extirpation  der 
Geschwulst  Heilung.”  Zentralbl.  Chir.,  47:547- 
550,  1920. 

4.  Torres,  A.  L.:  "Carcindide  de  anipola  de  Va- 
ter.” Arg.  Inst.  Biol.  Exercito,  10-13:53-56,  1953. 

5.  Brunschwig,  A.  and  Childs,  A.:  "Resection  of 
carcinoma  (carcinoid?)  of  the  intrapapillary  por- 
tion of  the  duodenum  invading  the  ampulla 
of  Vater.”  Am.  J.  Surg.,  45:320-324,  1939. 

6.  Hannan,  J.  R.,  Hazard,  J.  B.  and  Wise,  R.  E.: 
“Carcinoid  of  duodenum.”  Am.  J.  Roentgen., 
66:569-576,  1951. 

7.  Warren,  K.  W.  and  Coyle,  E.  B.:  “Carcinoid 
tumors  of  the  gastrointestinal  tract.”  Am.  J. 
Surg.,  S2:$12-317,  1951. 


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132 


Illinois  Medical  Journal 


The  doctor-patient  dyad: 


An  interpersonal  relationship  model 


Bv  H.  H.  Garner,  M.D./Chicago 


The  need  of  individuals  to  find  answers 
to  the  illnesses,  fears  and  uncertainties  of 
life  has  in  the  past  created  a corps  of  pro- 
fessionals who  feel  that  they  could  and 
should  answer  the  call  for  help.  This  corps  of 
helpers  to  those  saying— “I’m  sick  and  help- 
less’’—is  represented  by  the  physician.  To 
understand  the  nature  of  this  relationship 
and  why  it  works,  we  must  understand  the 
psychological  significance  of  the  role  of  the 
patient  as  a compliant,  non-compliant,  or 
critically  appraising  participant  in  the  field 
of  doctor-patient  interaction.  The  goals  for 
the  treatment  of  any  individual  and  the 
nature  of  the  treatment  process  will  be  re- 
lated not  only  to  the  physical  disability 
but  to  the  person  who  is  sick,  to  his  man- 
ner of  relating,  to  his  physician,  and  to  the 
potentials  for  establishing  a therapeutic 
focus  from  which  the  patient  can  benefit. 
The  doctor-patient  relationship  has  impli- 
cations for  both: 

For  the  physician  in  regard  to  the 
patient  it  implies:  1)  acceptance  of  the  pa- 
tient as  a person— his  interests,  strivings  and 
feelings;  2)  acceptance  of  the  right  of  the 
patient  to  find  his  own  solution  to  his  prob- 
lems; 3)  a respect  for  the  patient’s  emotion- 

This  study  was  supported  by  United  States  Pub- 
lic Health  Service  grant  no.  MH-8994  for  Con- 
tinuing Education  in  Psychiatry.  Portions  of  this 
paper  were  read  at  the  Meeting  of  the  American 
Academy  of  General  Practice,  Dallas,  Tex.,  Sept. 
18,  1967. 


ally  determined  attitudes  toward  his  illness 
and  the  physician. 

For  the  physician  in  regard  to  him- 
self it  implies:  1)  discipline  of  his  feelings, 
speech  and  behavior;  2)  control  of  impa- 
tience, hostility  and  prejudice. 

The  emphasis  in  medical  education  on 
the  acts  of  the  physician  directed  at  heal- 
ing the  patient  has  tended  to  blur  the  sig- 
nificance of  the  interactional  process  of  the 
doctor-patient  relationship.  It  is  toward  re- 
viewing, clarifying,  and  describing  some 
personal  concepts  about  that  relationship 
that  I direct  my  discussion. 

Models  of  patient-physician  relationships 

Having  made  the  diagnosis,  the  physician 
draws  a plan  of  action  based  not  only  on 
the  diagnosis,  but  also  on  the  unique  ca- 


ll. H.  Garner,  M.D.,  is 
professor  and  chairman,  dept, 
of  psychiatry  and  neurology, 
the  Chicago  Medical  School 
and  the  Mt.  Sinai  Hospital 
Medical  Center.  He  is  a re- 
searcher  in  confrontation 
techniques  and  methods  in 
psychotherapy,  and  a pioneer 
in  developing  continuing  edu- 
cation programs  in  psychiatry  for  non-psy- 
chiatrically  trained  physicians.  Dr.  Garner  re- 
ceived his  M.D.  from  the  University  of  Illinois, 
College  of  Medicine.  He  is  also  consulting  at 
the  V.A.  Hines  Hospital. 


for  August,  1970 


133 


pacities  and  limitations  of  the  physician, 
and  on  the  relationship  between  the  pa- 
tient and  physician.  This  relationship  has 
received  increased  attention.  The  following 
is  a graphic  illustration  of  Rado’s  model. 
It  is  particularly  applicable  to  a psycho- 
therapeutic process. 


Patient  to  doctor  attitude.  A physiologic 
reflex  action  at  instinctual  level. 

Clinical  significance  is  limited:  Sucking 
and  turning  movements  of  semi-stupor  may 
be  related,  i.e.,  hypoglycemia.  Deep  trance 
states  of  hypnosis  and  psychoanalysis  may 
contain  elements  of  primary  compliance. 


RADO’S  MODEL 

ASPIRING  LEVEL  EXPRESSED  ATTITUDES 


Available  in  an  adult  capable  I am  delighted  to  cooperate, 

and  desirous  of  self-advancement. 


SELE-RELIANT  LEVEL 


Adult  capable  of  learning  the  I am  ready  to  cooperate  but  I 

simple  know-how  of  daily  life.  must  learn  how  to  help  myself. 

ADULT 


CHILDLIKE 


PARENTIFYING  LEVEL 


•Vdult  acts  like  a child.  The  doctor  should  cure  me  by 

parentifies  the  therapist.  his  own  efforts. 

MAGIC  CRAVING  LEVEL 


Discouraged  adult  hopes  the  The  doctor  must  do  everything 

therapist  will  work  a miracle.  for  me  as  by  magic. 

The  following  model  has  greater  meaning  for  all  doctor-patient  contacts. 


SZASZ-HOLLENDER 


CLINICAL  PROTOTYPE 

APPLICATION  OF  ROLE 


1.  Activity 
Passivity 

2.  Guidance 
cooperation 


PHYSICIAN'S 
ROLE 

Does  something 
to  patient 

Tells  patient 
what  to  do 


PATIENT’S 

ROLE 

Unable  to  re- 
spond or  inert 

Cooperation— 

obeys 


.\nesthesia, 
acute  trauma, 
coma,  delirium 

Acute  infec- 
tious pro- 
cesses 


Parent-infant 


Parent-child, 
or  -adolescent 


3.  Mutual  par- 
ticipation 


Helps  patient 
to  help  himself 


Participant  in  Most  chronic  Adult-adult 

partnership,  illnesses, 

uses  expert  help  psychoanalysis, 
psychotherapy 


The  following  represents  what  I feel  is 
a valuable  concept  of  doctor-patient  rela- 
tionship, which  emphasizes  how  the  pa- 
tient’s attitude  toward  the  doctor  can  be 
recognized  and  understood  as  a guide  to 
promoting  restoration  of  health,  or  to  a 
previously  balanced  level  of  functioning, 
and  to  the  prevention  of  disorder  in  the 
future. 

COMPLIANCE-PRIMARY 

Originates  in  instinctual  need  to  turn 
toward  non-frightening  stimuli  in  the  en- 
vironment. The  base  from  which  conform- 
ing and  compliant  behavior  of  later  life 
develops  and  expands. 


COMPLIANCE  SECONDARY- 
UNCRITICAL 

Originates  in  infancy  and  childhood: 
Seeking  of  gratification— love— attention; 
avoids  punishment. 

Patient  to  doctor  attitude:  You  are  om- 
nipotent and  omniscient.  I surrender  my 
right  to  judgments  and  decisions. 

Clinical  significance:  A characteristic  re- 
sponse to  moderate  or  extreme  feeling  of 
helplessness,  fear  or  anxiety.  Most  patients 
will  respond  in  this  manner.  The  intensity 
gives  an  index  for  doctor-patient  manage- 
ment interventions. 


134 


Illinois  Medical  Journal 


SECONDARY  COMPLIANCE-AFTER 
CRITICAL  APPRAISAL 

Originates  m infancy  and  childhood: 
Seeking  gi  atitication;  the  avoidance  of  pun- 
ishment. 

Patient  to  doctor  attitude:  I am  basically 
trustful  of  you,  but  I would  prefer  to  have 
more  facts. 

You  seem  to  be  a person  who  can’t 
tolerate  any  questioning  or  accept  the 
opinion  of  others.  Since  I want  yon  and 
your  skills,  I will  accept  what  you  say 
without  questioning.  Uncritical  compli- 
ance is  fostered. 

Clinical  significance:  Seen  in  elective  sit- 
uations or  non-emergency  surgery.  The  doc- 
tor has  an  unusual  skill  or  has  a reputation 
of  having  a skill  which  the  patient  feels 
is  important  to  him.  The  patient  complies 
despite  his  awareness  of  non-compliant  feel- 
ings. 

CRITICAL  APPRAISAL 

Originates  in  the  earliest  and  later  ex- 
periences of  life  which  fortify  problem- 
solving confidence. 

Patient  to  doctor:  I am  observing  what 
you  do  and  say  with  discriminating  per- 
ceptions and  thought.  I will  respond  posi- 
tively if  what  you  say  and  do  makes  sense. 

Clinical  significance:  Usually  will  be 
most  evident  when  sense  of  helpless  anxiety 
and  fear  is  minimal.  The  patient  is  likely 
to  have  a minimum  of  unrealistic  attitudes 
about  the  omnipotent  character  of  authori- 
tarian figures. 

NON-COMPLIANT-UNCRITICAL 

Originates  in  the  unlearned  responses  to 
the  frustrations  during  earliest  experiences 
with  environment. 

The  learned  non-compliant  behavior  of 
infancy  and  childhood  as  a means  of  con- 
trolling significant  persons  (similar  to  con- 
ditioned responses  of  Pavlovian  experi- 
ments). Non-compliance  is  associated  with 
achievement  of  goals,  i.e.,  attention  as  a 
substitute  for  love  and  affection. 

Patient  to  doctor:  Automatic  rejecting 
and  non  acceptance  of  recommendations— 
I won’t,  I won’t,— I won’t  let  you  because 
I feel  I shouldn’t. 

Clinical  significance:  Children  in  fairly 
large  numbers  may  respond  by  such  atti- 
tudes to  first  and  subsequent  visits.  Adoles- 
cents and  adults,  who  see  the  physician 


as  a coercing  agent  or  punishing  figure, 
may  show  an  automatic  type  of  negativism. 

NON-COMPLIANCE-CRITICAL 

Originates  in  experiences  in  which  trust 
and  devotion  to  authority  was  followed  by 
painful  and  unpleasant  experiences. 

Patient  to  doctor:  I can’t  accept  recom- 
mendations from  you.  I refuse  because  I 
recognize  I can’t  trust  or  believe  you. 

Clinical  significance:  The  patient  recog- 
nizes the  recommendations  or  intended  ac- 
tions as  of  doubtfid  merit  and  as  not  in 
his  best  interests  and  often  provokes  hos- 
tility in  the  physician. 

The  Patient’s  Expectations 

I have  described  most  treatment  processes 
as  conducted  in  a two-person  social  system, 
i.e.,  the  doctor-patient  relationship.  The 
others  who  enter  this  field  of  interaction- 
intern,  resident,  nurse,  spouse,  parent,  sib- 
ling, friend— are  usually  subordinate  actors 
on  the  stage  of  the  patient-physician  trans- 
action. Most  workers  in  the  field  of  medi- 
cine are  well  aware  of  the  quid  pro  quo 
attitude  which  the  patient  manifests  about 
arrangements  for  medical  care.  This  atti- 
tude expresses  itself  in  the  patient  verbal- 
izing rather  freely  about  physical  sensa- 
tions, although  he  may  be  reserved  and 
suspicious  about  his  personal  troubles  or 
difficulties  wdth  others.  In  turn,  after  prop- 
er assimilation  and  coding  of  the  data,  he 
expects  some  action  by  the  physician  direct- 
ed at  alleviation  of  the  symptoms  or  troub- 
les. Aw'areness  of  the  patient’s  expectations 
is  frequently  expressed  in  medical  circles 
by  such  statements  as:  “You  have  to  give 
him  something’’— “The  patient  has  a right 
to  an  EGG.”  However,  there  is  insidficient 
awareness  that  the  process  of  giving  need 
not  be  in  the  form  of  a prescription,  a 
laboratory  examination,  a special  manipu- 
lation, or  some  magic  formula  for  recov- 
ery. Many  physicians  are  surprised  to  find 
that  the  patient  considers  adequate  value 
to  have  been  received  by  the  doctor’s  at- 
tentive listening,  understanding,  and  the 
offering  of  another  appointment  to  discuss 
the  problems  in  greater  detail.  Obviously 
there  is  need  for  a great  deal  of  re-orienta- 
tion  about  what  the  patient  considers  “val- 
ue received.’’ 

It  should  also  be  obvious  that  a patient 
suffering  from  a severe  migraine  headache. 


for  August,  1970 


135 


even  though  convinced  that  important  ele- 
ments of  his  problem  are  emotionally  in- 
duced, may  be  far  from  satisfied  with  a 
promise  of  further  study  and  exploration: 
he  expects  immediate  or  early  relief.  Be- 
hind the  patient’s  provisional  acceptance 
of  the  passive  listening  attitude  of  the  ther- 
apist is  an  expectation  that  some  process 
will  ensue  that  will  provide  relief.  The 
physician  can  put  to  good  use  this  expecta- 
tion which  the  dependent  person  displays. 
A child  undergoes  the  experience  that  the 
laying  on  of  a hand,  a caress,  a supporting 
arm  around  the  shoulcier,  an  attentive  and 
sympathetic  ear,  or  a kiss,  takes  the  hurt 
away,  or  at  least  diminishes  the  pain.  These 
healing  responses  are  attributed  by  the 
child  to  the  magic  power  of  his  parents 
and  projected  onto  the  doctor.  The  respons- 
es of  approval,  protection,  sympathy  and 
attention  are  sought  as  substitutes  for  the 
love  and  affection  expected  from  parents. 
Threats,  punishment  and  disapproval  are 
also  parental  reactions  which  the  patient 
may  anticipate  from  the  physician.  By  being 
a “good  patient”  he  diminishes  the  risk  of 
punishment  and  disapproval,  and  at  the 
same  time  enhances  the  probability  of  re- 
covery. Use  by  the  physician  of  this  type 
of  relationship,  however,  carries  with  it  the 
implication  that  a more  mature  and  more 
responsibly  adequate  relationship  cannot 
be  established. 

The  physician’s  personality 

The  personality  of  the  physician  is  an 
integral  factor  in  the  effects  produced  by 
all  his  treatment  devices,  whether  additive, 
sidrtractive,  or  manipulative.  The  flexibility 
of  the  physician  is  an  essential  quality  in 
the  management  of  the  patient.  A physician 
may  treat  a patient  in  hypoglycemic  stupor 
on  the  primary  compliance  level.  When  he 
becomes  conscious,  secondary  compliance 
may  characterize  the  patient’s  behavior.  A 
more  mature  attitude  with  critical  appraisal 
may  be  in  evidence  as  the  physician  dis- 
cusses possible  exploration  for  a suspected 
pancreatic  tumor.  The  following  are  but  a 
few  of  the  many  personality  traits  which 
have  significance  for  the  physician  in  the 
management  of  his  patients. 

Rigidity  and  an  unyielding  nature,  a 
preference  for  dealing  with  the  patient  on 
an  intellectual  level  as  though  he  were  a 
physiologic  object,  and  the  avoidance  of 


involvement  in  the  patient’s  emotional 
problems  are  qualities  in  the  physician 
which  significantly  influence  treatment— 
too  often  unfavorably. 

Identification  with  the  patient  affects 
some  physicians.  Renneker,  in  studies  of 
patients  with  breast  cancer,  found  that  the 
attending  physician  is  often  stirred  deeply 
through  identification  with  the  dying  pa- 
tient. The  desire  not  to  be  reminded  of  a 
previous  traumatic  experience  may  prevent 
an  attitude  of  empathy  which  would  be 
helpful  in  management.  The  undesirability 
of  positive  identification,  as  if  the  patient 
tvere  a close  personal  friend  or  an  intimate 
associate,  has  been  sufficiently  stressed. 

Authoritarianism  is  a part  of  every  doc- 
tor-patient relationship.  The  patient  often 
needs  and  expects  a certain  degree  of  such 
control.  Realistically,  this  should  vary  with 
the  degree  to  which  the  physician’s  special 
know’ledge  makes  it  desirable  that  he  make 
decisions  for  the  patient.  However,  too 
many  patients  have  strong  feelings  or 
passivity  and  dependency  which  drive  them 
to  extract  a maximal  degree  of  authorita- 
rian control  from  the  physician,  and  to 
avoid  taking  responsibility  for  self-manage- 
ment and  self-control.  They  will  react  with 
anxiety  and  undesirable  behavior  if  their 
needs  are  not  recognized.  Obsequiousness 
on  the  part  of  the  physician  toward  persons 
siqrposedly  in  a prestige  relationship  to  him 
may  jrrevent  development  of  the  doctor- 
patient  relationship  needed  for  therapeutic 
effectiveness.  It  creates  a situation  in  which 
the  patient  determines  the  therapeutic  pro- 
cedure. When  passive,  dependent  traits  are 
manifested  by  the  physician,  an  atmosphere 
of  doubt  is  created  about  the  wisdom  of  his 
therapeutic  procedures.  Some  patients  with 
anxiety  about  retaliatory  aggressiveness 
may,  however,  respond  to  treatment  ad- 
ministered by  the  more  passive  type  of 
physician  with  greater  comfort. 

The  quest  for  certainty 

This  universal  goal  has  a special  poig- 
nancy in  medical  practice.  It  is  present  in 
the  patient  seeking  help,  whether  for  a 
physical  or  an  emotional  disorder;  he  brings 
to  the  treatment  situation  certain  basic  de- 
sires which  Masserman  has  described  as  the 
basic  defenses  of  man.  In  essence,  the  pa- 
tient’s defenses  are:  1)  a feeling  of  indes- 
tructability;  2)  a belief  that  others  are  in- 


136 


Illinois  Medical  Journal 


teresLed  in  him,  even  to  the  point  ol  great 
personal  sacritice:  3)  faith  in  some  force 
or  power,  omnipotent  and  all-knowing, 
which  in  some  way  will  protect  him  against 
danger.  The  physician  is  a representative 
of  some  significant  figure  from  jtast  ex- 
perience. These  essential  defenses  are  util- 
ized by  the  patient  to  find  the  required 
qualities  in  the  physician.  Awareness  of  the 
patient’s  needs  for  such  defenses  to  help 
fortify  him  against  anxiety  and  fear  shoidd 
be  part  of  every  therapeutic  procedure. 

Parallel  with  the  patient’s  cjuest  for  cer- 
tainty is  the  physician’s  comparable  tjuest. 
Schwartz  and  Wolf  expressed  it  as  follows: 
“I  may  he  useful  in  exploring  the  prob- 
lems and  treatment  possibility  for  each  pa- 
tient to  think  in  terms  of  certainty  and  un- 
certainty, or  of  realistic  and  unrealistic  ef- 
forts to  achieve  certainty  and  how  this 
concept  plays  a role  in  effecting  therapeu- 
tic results.  Our  system  of  education  seems 
to  give  the  impression  that  for  every  ques- 
tion there  is  a singfe  definite  answer.  Every 
patient  likewise  hopes  for  a single,  simple, 
definitive  cure.  This  is  unfortunate  because 
the  problems  encountered  in  later  life  and 
their  solution  generally  cannot  be  answered 
tjuite  so  definitely.” 

The  quest  for  certainty  is  the  quest  for 
an  illusion.  The  patient’s  quest  for  certain- 
ty and  his  need  for  someone  to  help  him 
even  at  a personal  sacrifice  distorts  the 
image  of  the  physician  as  a person  when 
the  patient  is  experiencing  pain,  distress, 
anxiety  or  fear. 

Transference  of  attitudes  and  feelings 

Transference  is  the  term  most  commonly 
used  to  describe  distortion  of  the  doctor- 
patient  relationship  in  psychotherapy.  Rap- 
port, confidence,  acceptance,  empathy,  re- 
lationships, and  many  other  terms  are  used 
to  symbolize  that  interpersonal  reaction 
which  characterizes  the  contractual  involve- 
ments of  treatment.  These  phenomena  are 
seen  and  can  be  studied  as  elements  in  any 
system  in  which  one  person  seeks  help  and 
another  offers  help.  In  treatment,  many  of 
the  patient’s  perceptions  of  the  person  car- 
ing for  him  express  the  need  to  see  in  the 
therapist  the  protecting  or  neglecting,  the 
caring  or  the  injuring  roles  of  significant 
figures  in  his  past.  This  repetitive  tendency 
throughout  life  is  an  extension  of  the  prin- 
ciple involved  in  the  behavior  of  any  or- 


ganism-repetition of  the  adaptive  patterns 
which  earlier  had  been  operationally  suc- 
cessful. Infants  and  children  endow  parents 
with  God  like  magical  powers.  These  same 
attitudes,  expectations  and  powers  are 
transferred  by  the  patient  in  achdt  life 
to  his  transactions  with  the  physician.  Al- 
though such  reactions  are  a necessary  psy- 
chologic aspect  of  the  patient’s  healing 
process,  the  physician  must  not  accept  at 
face  value  what  the  patient  believes  about 
him.  Transference  attitudes  and  feelings 
incl  title: 

1 . Dependency  needs,  mobilized  by 
stress  of  any  kind,  may  be  expressed  realis- 
tically as  a dependence  appropriate  to  the 
disability,  with  recognition  of  the  probable 
limits  of  a competent  physician’s  ability  to 
lielp.  At  the  opposite  extreme,  these  needs 
may  be  expressed  unrealistically  even  to  the 
extent  of  creating  the  expectation  that  the 
physician  will  give  up  his  own  interests  in 
selfless  devotioti  and  accomplish  for  the  pa- 
tient what  is  beyond  currently  known  medi- 
cal science.  The  patient  literally  may  want 
to  remain  in  bed  with  all  of  his  needs  cared 
for,  even  to  being  fed  and  having  bowel 
and  bladder  functions  looked  after  by 
others.  Dependency  cravings  may  inadvert- 
ently be  encouraged  to  flow  from  the  ac- 
ceptable social  role  during  illness  into  a 
stage  of  regression  that  is  malignant  and 
nonreversible. 

2.  Denial  of  dependency  by  the  patient 
is  a defensive  bravado,  an  ignoring  of  his 
anxiety.  Such  a defense  may  suddenly  col- 
lapse into  a state  of  acute  panic  or  severe 
regression,  to  the  surprise  of  all  who  ac- 
cepted the  defense  at  face  value.  The  sick 
person  may  respond  with  combinations  of 
the  feelings  and  attitudes  described  under 
dependency  needs. 

.3.  Feelings  of  anger,  resentment,  and 
open  hostility  may  be  mobilized  by  un- 
realistic expectations.  Thus,  he  may  use 
the  doctor-patient  relationship  to  fortify 
a feeling  of  basic  distrust. 

4.  Feelings  of  guilt  may  be  manifesta- 
tions of  the  patient’s  hostile  and  aggres- 
sive intentions. 

5.  Erotic  feelings  and  shame  may  be 
aroused  by  undressing.  Examinations  and 
expressions  of  interest  by  the  physician, 
especially  with  regard  to  the  erogenous 
zones,  may  be  interpreted  as  having  an 
erotic  motivation. 


for  August,  1970 


137 


6.  Feelings  of  envy  and  jealousy  oc- 
casionally interfere  with  the  realistic  doc- 
tor-patient relationship:  other  patients  may 
be  getting  better  treatment. 

7.  Anxiety  and  fear  may  be  aroused 
by  transferred  feelings  related  to  anticipated 
punishment  and  withdrawal  of  approval 
producing  concerns  about  a possible  male- 
volent use  of  these  powders  in  expressions 
of  anger  and  hate. 

The  patient’s  perceptions  of  the  doctor’s 
office,  the  waiting  room  and  other  elements 
of  his  hrst  introduction  to  the  healer  are 
colored  by  transference  feelings.  If  the  of- 
hce  is  unusually  crowded,  the  doctor  be- 
comes endowed  with  powerful  magic;  peo- 
ple must  seek  his  help  in  such  large  num- 
bers because  he  is  so  effective.  If  the  pa- 
tients are  few,  then  it  is  implied  that  much 
time  is  consumed  in  the  care  of  each,  and 
the  doctor  must  then  limit  his  practice  and 
show  an  unusual  interest  in  each  patient 
he  admits.  Each  item  in  the  office  is  used 
by  the  patient  in  this  variable  fashion  to 
document  what  he  wishes  to  believe  about 
the  doctor. 

The  physician’s  attitude  toward  the 
patient 

Emphasis  on  a knowledge  of  self,  so  im- 
portant in  the  treatment  of  patients  with 
emotional  illness,  applies  to  the  treatment 
of  all  patients.  The  physician  needs  to  face 
maturely  any  strong  feelings  of  like  or  dis- 
taste for  his  patient.  Gerty  wrote  that  the 
physician,  in  his  devotion  to  his  calling, 
may  have  to  combat  at  times  disliking  the 
things  he  has  to  do.  He  must  not  dislike 
humanity,  and  must  have  some  measure  of 
charity  and  tolerance  for  its  foibles,  weak- 
nesses, and  prejudices.  Our  previous  experi- 
ences contribute  to  the  attitudes  we  de- 
velop toward  our  patients.  Significant 
among  all  these  are  the  conditioning  experi- 
ences of  our  medical  education.  Stoller  and 
Geerstma,  in  a study  of  student  attitudes, 
found  that  medical  students  prefer  to  view 
even  the  emotionally  ill  person  from  the 
point  of  view  of  organic  pathology.  An- 
xiety mounts  as  they  have  closer  contact 
and  responsibility  for  mentally  ill  patients. 
This  helps  create  the  attitude  that  an  or- 
ganically ill  patient  is  more  desirable  than 
the  emotionally  ill  person.  The  physician, 
whatever  his  specialty,  has  the  responsibility 
of  learning  about  such  personal  attitudes 


(jDositive  or  negative)  toward  patients.  In 
this  way  personal  and  professional  judg- 
ments may  come  closer  to  being  harmon- 
ized for  the  welfare  of  the  patient. 

Countertransference  is  a term  used  for 
the  physician’s  reaction  to  the  patient,  with 
feelings  and  attitudes  similar  to  those  he 
has  manifested  toward  signihcant  persons 
in  his  past.  These  are  counterparts,  in  the 
physician,  to  the  patient’s  transference  feel- 
ings. Responses  to  patients  which  are  ex- 
pressions of  countertransference  are  there- 
fore not  based  upon  the  reality  of  the  si- 
tuation. They  are  attitudes  which  contami- 
nate treatment.  Guilt  feelings  may  lead  to 
treatment  that  does  not  go  as  far  as  it 
should,  or  that  goes  too  far.  An  attitude  of 
reserve  may  prevent  adequate  examination 
of  the  patient.  Strong  feelings  of  superiority 
may  mobilize  attitudes  and  feelings  w’hich 
have  been  described  as  “the  God  complex” 
by  several  authors. 

Countertransference  feelings  are  to  be 
distinguished  from  those  which  are  reason- 
able, realistic,  and  appropriate  to  the  cir- 
cumstances. A patient  may  be  excessively 
demanding,  rnde  and  improper  in  his 
speech,  manner  and  dress  or  in  other  ways 
behave  unacceptably  and  offensively.  The 
physician,  as  a human  being,  may  react  to 
stich  behavior  wuth  evident  displeasure  and 
non-acceptance.  On  the  other  hand,  the 
physician’s  function  in  society  realistically 
recjuires  that  he  manifest  a tolerant  non- 
condemning reaction  and  an  aw'arencss  that 
deviant  behavior  may  be  one  expression 
of  illness.  The  degree  to  which  he  can  be 
objective,  and  react  with  understanding 
rather  than  with  anger,  impulsiveness,  and 
retaliatory  or  overtly  aggressive  behavior  is 
a measure  of  the  physician’s  awareness  of 
his  role  in  society  and  the  maturity  of  his 
relationship  to  patients.  The  patient’s  posi- 
tive feelings  of  dependence,  confidence,  se- 
curity, affection  and  overt  intimate  display 
may  also  arouse  erotic  feelings.  It  may  be 
understandable  that  the  patient  sees  the 
physician  as  a priest,  a deity,  or  an  adonis, 
but  it  is  indeed  an  error  in  judgment  for 
the  physician  to  accept  these  attitudes  as 
realistic.  The  physician’s  therapeutic  focus 
and  the  interventions,  which  should  logi- 
cally flow  from  the  relationship,  readily  fall 
into  place. 


138 


Illinois  Medical  Journal 


PATIENT  THERAPEUTIC 


ATTITUDE 

FOCUS 

PHYSICIAN 

INTERVENTIONS 

Compliance 

Cure  and  relief  of  .symp- 

/ A.'king 

Rituals 

toms.  Relief  of  anxiety 

j (jueslions 

Magical  instruments 

wliitli  tlien  permits  fur- 

/ C.larilication 

Magical  potions 

ther  exploration.  Prevent 

.Mwa  ys 

/ .\dvice 

Change  of  environment 

re  c u r re  n CCS — f os  t c r re  h a ■ 

Em|)hasized 

\ Reassurance 

.\on-verbal  influences 

bilitation  cllorts 

\ Persuasion 
' .Suggestion 

Critical 

Cure  and  relief  of  symp- 

Important 

/ ,\sking 
^^ejuestions 

lnter|)retation  of  in- 

.\|)prai.sal 

toms.  Increased  adaptive 

lerpersonal  attitudes 

capacitv.  Precention  of 

,ind  behavior,  its  gene- 

recurrence.  Decrease  se- 

Where  plnsician 

( lai  ilication 
.Vdvice 

tic  origins.  ;ind  the 

verity  and  intensity  of  re- 

is  expert 

transfer  of  past  atti- 

(.m  rente 

/ Reassurance 
Persuasion 
\ Suggestion 

tildes  to  present  rela- 
tionshi|)  with  doctor. 
.\ on  - verba  1 i n fl  uences 

Minimal  use 

Non-Compliaucc 

Comersion  of  non-accc’pt- 

Directed  at 

/ Asking 
tjuestions 

Interxentions  with  aid 

ance  of  patient  role  to 

b.isic  attitude 

of  parent  or  guardian. 

one  of  acceptance. 

^ Clarification 
\ .\dvice 

Attention  is  directed 

Proceed  with  therapeutic 

When 

toward  the  res]}onse  to 

fcKus  as  for  com]3liance  or 
critical  appraisal 

appropriate 

imticipated  rejection, 
coercion  or  injury. 

If  expected  to 

/ Reassurance 

Non-verbal  influences 

increase  tom- 

^ Persuasion 

pliant  or  ap- 
praising attitude 

^ Suggestion 

References 

Therapy.  Williams  & 

Wilkins  Co.,  Baltimore, 

Brosin,  H.  W.:  “The  Doctor  and  His  Patients,” 
Postgrad.  Med.  20:528-531,  1956. 

Garner,  H.  H.:  “Treatment— Review  of  a 

Medical  Concept,”  J.  Amer.  Geriat.  Soc.  9:883- 
910,  1961. 

Garner,  H.  H.:  “Compliance  and  Problem-Solv- 
ing Psychotherapy,”  Compr.  Psychiat.  7:21-30, 
1966. 

Garner,  H.  H.:  “Brief  Psychotherapy,”  Int.  J. 
Neuropsychiat.  1:616-622,  1965. 

Garner,  H.  H.:  “Somatopsychic  Concepts,” 

Psychosomatics  7:329-337,  1966. 

Gerty,  F.  J.:  "Use  and  Misuse  of  Psychiatry  in 
General  Practice,”  Chicago  Medical  Soc.  Bull. 
57:447,  (Dec.)  1954. 

Masserman,  J.  H.:  The  Practice  of  Dynamic 
Psychiatry.  W.  B.  Saunders  Co.,  Philadelphia, 
1955. 

Rado,  S.:  in  Wortis,  B.  (ed.):  Psychiatric 


1953. 


9. 


10 


Renneker,  R.  and  Cutler,  M.:  “Psychological 
Problems  of  Adjustment  to  Cancer  of  the 
Breast,”  J.A.M.A.  148:833-838,  Mar.  8,  1952. 
Schwartz,  E.  K.  and  Wolf,  A.:  “The  Quest  for 
Certainty,”  A.M.A.  Arch.  Neur.  Psychiat  81:69- 
84,  1959. 

11.  Stokes,  A.  B.:  “Symposium  on  Psychological 
Aspects  of  Medicine;  Psychological  Effect  of  the 
Patient  on  the  Doctor,”  M.  Clin.  North  Ameri- 
ca 36:585-592,  1952. 

12.  Stoller  R.  J.  and  Geerstma,  R.  H.:  “Measure- 
ment of  Medical  Students’  Acceptance  of  Emo- 
tionally 111  Patients,”  J.  M.  Educ.  33:585-590, 
1958. 

13.  Szasz,  T.  S.  and  Hollender,  M.  H.;  “A  Con- 
tribution of  the  Philosophy  of  Medicine:  Basic 
Models  of  the  Doctor-Patient  Relationship,” 
A.M.A.  Arch.  Int.  Med.  97:585-592,  1956. 


Anticipating  the  Census 

The  1970  census  will  soon  tell  officially  how  many  people  there  are  in 
this  country.  Even  without  the  census,  certain  facts  are  fairly  well  estab- 
lished about  the  country's  population  growth.  For  instance, 

• Every  9 seconds  someone  is  born  in  this  country. 

• Every  Id’A  seconds  there  is  a death. 

• Every  60  seconds  an  immigrant  arrives. 

• Every  23  minutes  a citizen  leaves  to  reside  in  another  country. 

The  net  result? 

An  addition  to  our  population  every  ISVz  seconds.  This  figure,  extended, 
means  four  new  citizens  in  just  over  a minute;  over  232  per  hour;  and 
an  increase  of  more  than  5575  every  24  hours. 


for  August,  1970 


139 


Medical  Progress 


Harvey  Kravitz,  M.D. 
Medical  Progress  Editor 


Coramunity 


By  Louis  D.  Boshes,  M.D.  and  Hans  W.  Kienast,  M.D./Chicago 


In  the  convulsive  slate,  the  complete  control  of  seizures, 
by  drugs  or  even  by  surgery  is  the  ultimate  goal.  In  epilepsy, 
more  than  with  most  diseases,  the  unit  of  treatment  is  first, 
the  family,  and  then  the  community.  In  discussing  the  com- 
munity problems  related  to  epilepsy,  one  first  must  have  a 
basic  foundation  concerning  some  of  the  concepts  and  the 
facts  revolving  around  this  symptom.  Certainly,  epilepsy  is 
not  a disease  per  se  but  refers  to  one  or  more  of  a symptom 
picture  that  is  noted  or  even  considered  as  a clinical  entity. 
The  word  “epilepsy”  is  derived  from  a Greek  preposition 
and  an  irregular  verb;  the  combined  word  denotes  the 
meaning  of  “to  seize  upon,”  “to  catch,”  “to  overtake,”  or 
“to  lay  hold  of.”  This  word  has  been  in  usage  for  many 
centuries  and  still  describes  a series  or  group  of  symptoms 
characterized  by  a sudden,  involuntary,  paroxysmal  episode 
which  tends  to  recur  unexpectedly.  This  episode  is  also 
known  as  “a  fit,”  “an  attack,”  “a  spell,”  “a  convulsion,”  or 
even  a “convulsive  seizure.” 


The  word  “epilepsy”  remains  a terrifying 
sound  to  many  people.  Unfortunately, 
down  through  the  centuries,  prejudices  and 
superstitions  have  accumulated  heavily 
around  this  word.  It  is  quite  understand- 
able that  certain  mysteries  and  fear  are 
associated  with  a person  who  suddenly, 
with  no  evident  reason,  cries  out,  starts  to 
twitch,  convulses,  lapses  into  a deep  sleep 
and  then,  upon  waking,  reveals  a dull  and 
even  blurred  mental  state.  Even  today, 
there  are  many  who  believe  in  witchcraft, 
feeling  that  persons  with  epilepsy  are 
possessed  by  the  devil.  Many  families  are 
still  burdened  by  this  ignorance,  stigma 
and  prejudice.  It  is  not  uncommon  for 
some  segments  of  our  population  to  make 
regular  pilgrimages  to  holy  shrines  for  the 


alleviation  of  this  symptom  in  the  family 
member.  Others  come  to  their  physicians 
asking  for  or  are  told  that  surgery  must  be 
done  to  remove  the  “devil.”  Appendec- 
tomies, herniotomies,  circumcisions,  or 
even  “re  adjustment”  or  “stripping  of  the 
carotid”  for  alleviation  of  the  seizure  pat- 
tern, are  still  being  done.  Craniotomies  are 
done  in  some  parts  of  the  world  to  break 
up  a seizure  pattern,  and  in  a small  meas- 
ured percent  this  procedure  is  strangely 
successful. 

Epilepsy  in  Childhood 

Reaction  between  the  convulsive  state 
and  the  social  environment  is  especially  im- 
portant in  the  young  child  with  seizures. 
Environmental  effects  may  thus  become  an 


140 


Illinois  Medical  Journal 


aspects  of  epilepsy 


integral  part  of  his  makeup,  his  behavior, 
and  his  adjustment  as  he  and  his  family 
attempt  to  maintain  a respected  and  com- 
fortable spot  within  the  community.  Cer- 
tainly, this  is  dependent  upon  the  frequen- 
cy of  episodes.  There  are  some  children 
who  are  unaware  of  any  episode  inasmuch 
as  many  of  these  may  occur  at  night  or 
perhaps  they  may  be  so  mild  and  transient 
to  cause  only  a very  small  or  even  an  in- 
conspicuous cessation  of  routine  activity. 
Other  children,  however,  are  not  as  for- 
tunate and  eventually  become  fearful  and 
dread  an  episode,  which  results  in  sudden 
and  unprovoked  embarrassment,  and  later 
in  dullness  of  thinking  following  a major 
attack.  As  this  child  grows  older,  he  may 
continue  to  experience  more  attacks  to  such 
a degree  that  he  will  be  looked  upon  as 
unusual,  peculiar,  and  certainly  be  dubbed 
as  “different”  from  other  children  in  his 
group.  His  only  recourse  then,  is  to  accept 
this  unhappy  state,  withdraw,  become  se- 
clusive  and  selfconscious,  with  lack  of  any 
type  of  social  intercourse  with  other  chil- 
dren. Eventually,  he  may  display  other 
signs  and  symptoms  denoting  his  continu- 
ing emotional  stress,  strain,  and  turmoil. 
Frustrating  restrictions  can  only  occur  and 


even  worsen  the  child  as  routine  expected 
competition  continues  in  his  growth  and 
development.  Eventually,  as  an  adult,  these 
same  symptoms  will  remain  and  even  con- 
tinue as  a responsible  cause  for  unpopu- 
larity in  the  community. 

Yet,  there  is  a small  group  of  children 
who  have  episodes,  the  etiology  of  which 
includes  structural  defects  or  injury  to  the 
brain.  This  child  may  suffer  from  physical 
and  mental  limitations  characterized  by 
mental  retardation,  visual  and  hearing  de- 
fects, behavioral  problems,  and  other  symp- 
toms, all  manifestations  of  his  condition 
of  cerebral  palsy.  In  spite  of  these  handi- 
caps, social  acceptance  for  this  child  can 
still  be  obtained.  A future  is  generally 
planned  and  assured  for  this  child  to  in- 
clude his  education,  his  vocational  guid- 
ance, and  later,  with  proper  rehabilitation, 
the  certainty  of  a responsible  place  or  even 
a role  in  his  community.  How  much  more 
fortunate  is  the  child  with  cerebral  palsy  as 
compared  to  the  one  with  epilepsy? 

Obviously,  parents  of  children  with  seiz- 
ures may  also  feel  stigmatized  and  have  a 
sense  of  social  ostracism.  They  may  feel 
guilt  or  anxiety  which  is  difficult  to  con- 
ceal from  a child  or  from  the  community. 


Louis  D.  Boshes,  M.D.,  (left)  is  clinical  professor  of  neu- 
rology attending  in  the  Research  and  Education  Hospital,  and 
director  of  the  Consultation  Clinic  for  Epilepsy  at  the  Univer- 
sity of  Illinois.  He  is  also  senior  attending  neurologist  and  psy- 
chiatrist, and  chief  of  the  Neurology  Clinics  at  the  Michael 
Reese  Hospital  and  Medical  Center.  Author  of  several  articles 
on  epilepsy  and  Parkinson’s  disease.  Dr.  Boshes  is  on  several 
national  neurological  advisory  boards  and  a member  of  many 
editorial  boards  of  neurologic  journals.  Hans  W.  Kienast,  M.D., 
(right)  is  an  associate  instructor  in  neurology  at  the  Uni- 
versity of  Illinois  College  of  Medicine,  and  attending  neuro- 
psychiatrist at  Illinois  Masonic  and  St.  Joseph  Hospital.  He  is 
also  the  author  of  numerous  articles  on  neurology. 


for  August,  1970 


141 


In  turn,  then,  this  child  tends  to  shun  peo- 
ple, beginning  first  with  his  own  family 
members.  He  will  not  accept  parental  at- 
titudes of  overprotection  and  overindul- 
gence which  later  can  only  become  com- 
plete rejection.  Often  there  exist  parents 
who  are  afraid,  or  even  unable  or  unwill- 
ing to  assume  responsibility  of  planning  or 
providing  funds  necessary  for  the  medical 
attention  for  the  guidance  of  an  epileptic 
child.  Still  others  are  so  poorly  informed 
about  assistance  which  is  available  that  they 
will  never  seek  it. 

What,  then,  is  the  outlook  for  such  a 
depleted  child?  With  the  present  develop- 
ment of  more  concise  and  improved  diag- 
nostic measures,  together  with  the  advent 
of  effective  anticonvulsant  drugs,  the  out- 
look for  an  individual  with  seizures  is 
vastly  improved.  On  the  other  hand,  if  the 
child  is  neglected,  he  has  a disorder  which 
can  handicap  him  physically  and  emo- 
tionally. At  the  present  time,  and  with  our 
modern  medical  armamentarium,  almost 
80%  of  children  suffering  with  seizures  may 
respond  adequately  to  treatment,  10-15% 
may  be  improved,  and  1-5%  remain  stabi- 
lized. Statistically,  there  is  conclusive  evi- 
dence to  show  that  the  symptoms  of  epi- 
lepsy may  cease  or  drop  out  over  a period 
of  many  years  and  even  be  in  a remissive 
state  for  many  years. 

Medical  management  alone  cannot  attain 
all  the  desired  effects  in  complete  control 
of  the  child’s  physical  and  emotional  in- 
volvement. Prejudicial  social  attitudes  must 
Ire  overcome  and  removed  to  such  a de- 
gree that  the  child  with  seizures  may  live, 
play,  work,  or  operate  in  a normal  compe- 
titive situation  and  become  a contributing 
citizen  within  this  community.  Although 
there  may  be  good  medical  management 
and  satisfactory  vocational  guidance,  an 
enlightened  public  opinion  will  greatly  in- 
crease the  opportunities  for  an  individual 
with  seizures. 

For  each  individual,  there  exists  a dif- 
ferent combination  of  factors  that  some- 
times defy  evaluation.  The  type  of  seizure 
must  be  determined,  the  etiology,  the  age 
of  onset,  the  management  and  its  effective- 
ness, the  physical,  emotional,  or  even  in- 
tellectual difficulties,  and  finally,  one  must 
learn  the  relationship  of  his  family  to  the 
community.  These  are  the  constant  varia- 
bles which  exist. 


Incidence  and  Onset  of  Epilepsy 

In  this  country,  there  are  well  over  two 
million  people  with  seizures.  Local,  state, 
and  national  surveys  offer  a basis  for  ap- 
proximations of  the  incidence,  but  there 
are  limitations  to  the  data  which  are  re- 
ceived. Reports  may  not  be  complete  or 
accurate.  There  are  some  patients  who  are 
misdiagnosed  and  there  are  still  others 
whose  diagnosis  is  concealed.  Fortunately, 
more  and  more  people  with  seizures  now 
seek  treatment  so  that  the  numbers  may 
increase.  Figures  as  high  as  four  million 
have  been  posed  in  some  quarters. 

As  w'e  know,  epilepsy  can  attack  all  age 
groups,  but  seems  most  prevalent  in  chil- 
dren. Seizures  are  more  commonly  seen  in 
the  initial  four  years  of  life  and  the  age 
of  onset  in  50%  of  the  known  cases  is  un- 
der 15  years.  For  this  reason,  early  recog- 
nition and  proper  diagnosis  is  obviously 
vital.  Good  management  must  be  offered 
in  these  developmental  years  to  prevent 
severe  psychosocial  effects  in  later  life 
which  are  bound  to  happen,  under  any 
condition. 

It  is  noted  that  patients  with  epilepsy  are 
appearing  before  physicians  with  increas- 
ing regularity  and  this  may  be  due  to  the 
availability  of  better  evaluation  and  man- 
agement. On  the  other  hand,  more  chil- 
dren survive  illnesses  due,  perhaps,  to  mod- 
ern medical  management.  Children  with 
prematurity,  developmental  anomalies, 
birth  trauma,  severe  infections,  and  head 
injuries  now  live  longer  with  seizures  so 
that  statistics  are  more  accurate. 

Epilepsy  is  costly  to  society  and  there 
is  a considerable  expenditure  involved  in 
institutional  care,  amounting  to  many  mil- 
lions annually.  Despite  the  fact  that  the 
largest  percentage  of  patients  with  seizures 
need  not  be  confined  to  institutions,  a great 
proportion  of  those  who  live  at  home  can- 
not attain  regular  employment.  If  the  full 
impact  of  the  finest  rehabilitation  services 
available  were  brought  to  bear  on  this 
large  group,  the  economic  contributions  of 
those  restored  to  society  would  be  substan- 
tial and  gainful. 

There  is  no  chronic  medical  condition 
more  affected  by  the  social  condition  of  the 
patient  than  is  epilepsy.  Only  alcoholism 
runs  epilepsy  a close  second.  Public  misun- 
derstanding not  only  hampers  progress  in 
developing  services  but  forces  some  kind 
of  unsatiable  social  climate  in  which  a pa- 


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tient  subject  to  seizures  cannot  expect  to 
find  acceptance  or  encouragement.  Cer- 
tainly, then,  promotion  of  a better  under- 
standing and  improvement  of  public  atti- 
tude would  be  the  primary  goal  of  com- 
munity service. 

Professional  Care  and  Assistance 
The  diagnosis  of  a patient  with  epilepsy 
can  be  somewhat  difficult,  and  frequently 
involves  the  opinion  of  many  specialists 
and  certain  complex  diagnostic  studies. 
Those  skilled  in  the  diagnosis  and  manage- 
ment of  seizures  are  few  and  these  physi- 
cians tend  to  congregate  in  large  popula- 
tion areas  or  in  university  centers.  Accord- 
ingly, there  is  a scarcity  and  an  uneven  dis- 
tribution of  needed  professional  workers 
and  facilities  in  the  rural  areas.  At  the 
present  time  there  is  the  Epilepsy  Founda- 
tion of  America,  and  through  the  efforts  of 
this  group,  a much  better  liaison  between 
the  patient  and  the  specific  areas  for  his 
service  demands  are  provided.  Thus,  these 
various  sources  can  be  mobilized  with  the 
community  action  to  include: 

1.  Specific  diagnostic  facilities  evaluation 
with  periodic  re-evaluation. 

2.  Medical  management  and  health  su- 
pervision. 

3.  Education  on  a regular  or  even  on  a 
special  basis. 

4.  Vocational  services,  testing,  counseling, 
training  and  ultimate  placement. 

5.  Social  work,  mental  health  guidance 
and  parent  counseling. 

6.  Hospitalization,  if  needed,  and  institu- 
tional care,  if  required. 

7.  Recreational  projects  and  facilities. 

A variety  of  personnel  is  required  to 
bring  children  and  services  together  to  car- 
ry out  the  different  phases  of  management 
within  a community.  These  key  people  in- 
clude parents,  physicians,  nurses,  teachers, 
social  workers,  psychologists  and  vocational 
counselors.  Even  religious  leaders  of  the 
various  faiths  should  be  enlisted.  To  im- 
prove the  matter  of  prevention,  public  edu- 
cation professional  training,  and  research 
become  other  important  features  of  a com- 
prehensive community  program.  Such  a 
broad  approach,  involving  health,  educa- 
tion, social  and  vocational  resources,  and 
a general  directed  attack  by  the  citizenry, 
can  aid  through  cooperative  efforts,  in  the 
fulfillment  of  a bold  and  integrated  plan. 


The  responsibility  for  seeing  to  it  that 
children  with  handicapping  seizures  will 
receive  adequate  care  rests  upon  specific  in- 
dividuals and  special  groups  within  any 
community.  In  the  past  decade,  increased 
interest  in  the  problems  of  seizures  has  been 
demonstrated  and  the  ground-work  for  im- 
proved services  is  being  laid  constantly. 
Local,  state,  and  national  groups  are  recog- 
nizing epilepsy  as  a health  problem  requir- 
ing directed  community  action.  At  present 
there  are  certain  programs  cooperatively 
financed  by  the  state  and  Federal  Govern- 
ments providing  diagnostic  treatment  cen- 
ters. Also,  citizen  groups  have  been  organ- 
ized to  promote  public  interest  in  epilepsy. 
Even  lay  societies  provide  direct  care  for 
the  individual.  Professional  associations,  in- 
cluding those  that  I have  mentioned,  to- 
gether with  the  “mother  society,”  the 
American  Epilepsy  Society,  and  with  the 
cooperation  of  medical  societies,  are  in  a 
favorable  position  to  provide  leadership 
and  support  in  improving  the  quality  of 
care  required  and  offered  to  each  indi- 
vidual with  seizures. 

Evaluation  of  the  Epileptic 

Most  of  the  personal  and  social  problems 
facing  children  with  recurrent  seizures  are 
essentially  the  same  as  those  facing  other 
groups  of  handicapped  individuals.  Is  there 
a special  profile  of  an  individual  with  epi- 
lepsy? Who  is  he?  and  What  can  he  do? 
What  can  he  be?  Actually,  an  epileptic  pa- 
tient is  not  any  unusual  type  of  person. 
He  may  be  found  anytime  and  anywhere 
within  the  cross  section  of  our  society. 
From  an  economic  point  of  view  he  may 
be  poor,  comfortable,  even  rich.  Physically, 
he  may  be  strong,  weak,  or  even  of  medium 
strength.  From  the  personality  point  of 
view,  he  may  be  attractive,  non-attractive, 
indifferent,  or  even  cantakerous.  Upon  this 
cross  section  of  a person,  then  has  been 
grafted  a symptom  which  can  be  recurrent 
or  which  varies  greatly  in  frequency  and 
intensity.  Differences  exist,  therefore,  in  the 
limiting  factors  for  individual  progress.  If 
this  person  is  a child,  he  may  bring  social 
and  psychologic  difficulties  on  to  himself 
as  well  as  to  others  around  him,  which  may 
be  unusually  subtle,  severe  and  continuous. 
One  must  probe  deeply  into  the  personal 
life  of  the  child  to  observe  all  mental,  so- 
cial, economic,  emotional  and  environmen- 
tal factors  involved.  Such  an  evaluation  also 


for  August,  1970 


143 


implies  an  assessment  of  the  positive  factors 
which  can  be  used  constructively  in  pro- 
moting control  of  his  seizures  and  later  re- 
habilitation of  the  total  physical  structure. 

The  psychological  appraisal  should  also 
be  defined  to  facilitate  selection  of  appro- 
priate test  procedures.  A determination  of 
the  level  and  quality  of  a child’s  mental 
functioning  should  be  made  and  this  per- 
sonality pattern  response  generally  proves 
its  value.  A certain  behavioral  response  may 
have  a direct  effect  upon  the  child  within 
his  community. 

It  is  important,  then,  to  collect  as  much 
information  as  is  possible  in  terms  of  recom- 
mendations for  home  and  school  manage- 
ment, the  later  educational  placement,  the 
vocational  goals,  and  if  necessary,  referrals 
to  psychologic,  psychiatric,  or  social  service 
studies  must  be  made. 

It  is  important  to  investigate  the  patient’s 
early  social  history,  growth  and  behavior, 
intellectual  capacity,  capabilities,  and  limi- 
tations, as  well  as  his  feelings  and  attitudes 
about  his  own  seizures.  One  must  collect 
information  from  the  patient’s  family  and 
home  to  include  cultural,  psychologic,  and 
social  factors.  Also,  the  past  history  must  be 
evaluated  carefully,  particularly  to  include 
parental  and  sibling  feelings  toward  the 
child’s  seizures.  Apart  from  the  home  en- 
vironment, one  must  learn  the  aspects  of 
the  community  in  which  the  child  with 
epilepsy  lives.  Here  should  be  ascertained 
the  attitudes  of  the  neighbors,  school, 
teachers,  religious  leaders,  camp  groups,  so- 
cial clubs  and  the  Boy  Scouts,  concerning 
the  youngster’s  seizure  state.  Well  known 
are  the  experiments  of  the  two-month  va- 
cational  periods  at  a camp  in  St.  James  in 
Normandy,  where  complete  physical,  neu- 
rologic, psychologic,  and  laboratory  studies 
are  made  on  children  in  a relaxed  atmos- 
phere. There  is  careful  integration  of  medi- 
cal, psychologic,  and  social  factors  which 
are  evaluated  during  the  time  the  children 
are  in  camp.  Similar  experiments  are  being 
conducted  at  the  Epilepsy  Centre  in  “Meere 
en  Bosch,”  in  Heemstede,  the  Netherlands, 
under  the  aegis  of  Dr.  A.  M.  Lorentz  de 
Haas.  Dr.  J.  C.  Bowe  has  developed  such 
a school  in  Lingfield,  Surrey,  England. 

Again,  a psychosocial  appraisal  of  any 
child  who  has  seizures  should  be  concerned 
with  the  following  important  questions: 

1.  What  are  his  specific  personality  char- 
acteristics? 


2.  How  good  is  his  emotional  adjustment 
to  his  seizure  picture? 

3.  How  do  seizures  affect  his  personality 
and  psychologic  equilibrium? 

4.  In  what  way  are  the  seizures  affected 
by  his  psychologic  problem? 

5.  What  factors  other  than  the  seizures 
account  for  any  disturbance  in  his  be- 
havior or  emotion? 

6.  Does  the  child  have  personality 
strength  or  attributes  to  assist  him? 

7.  What  does  the  child  think  of  himself 
as  one  who  has  “spells?” 

Public  feeling  and  misunderstanding 
about  epilepsy  have  produced  in  many 
communities  an  unsatisfactory  social  milieu 
in  which  to  bring  up  children  with  seizures. 
Earlier  it  was  stated  that  epilepsy  is  still 
associated  with  superstitions  in  certain  cul- 
tures. Unfortunately,  society  has  tended  to 
classify  all  epileptic  patients  together,  con- 
sidering them  as  pitiful,  incurable  indi- 
viduals who  require  isolation. 

Over  a period  of  some  25  years,  Drs.  Wil- 
liam E.  Caveness  and  H.  Houston  Merritt, 
inspired  by  the  interest  of  the  late  Dr. 
William  G.  Lennox,  have  made  a survey  in 
conjunction  with  Dr.  George  H.  Gallup, 
to  evaluate  current  trend  of  opinion  and 
public  attitudes  toward  epileptics.  A series 
of  questions  was  formulated  by  Drs.  Len- 
nox, Merritt,  and  Caveness  to  include  mat- 
ters such  as  familiarity  with  epilepsy,  ob- 
jections of  children  playing  with  epileptics, 
whether  epilepsy  is  believed  to  be  corre- 
lated with  insanity,  and  the  question  of 
employment  in  epilepsy.  There  is  no  ques- 
tion that  there  has  been  an  improvement 
in  the  epileptic  lot  and  it  is  apparent,  too, 
that  this  trend  is  continuing.  These  latest 
are  most  encouraging  from  the  point  of 
view  of  the  individual  and  his  region  of 
the  country. 

Service  and  facilities  must  be  provided 
for  those  who  have  seizures,  which  explains 
in  part  the  difficulties  lay  groups  encounter 
in  stimulating  or  organizing  community 
support  of  an  epilepsy  program.  To  meet 
full  responsibilities  for  children  under 
their  care,  even  well  informed  professional 
persons  should  examine  their  own  atti- 
tudes toward  epilepsy.  They  should  also 
seek  more  opportunities  within  their  com- 
munities to  correct  misconceptions  or  ideas 
of  the  seizure  state  and  to  help  broaden 
knowledge  to  contribute  to  better  under- 
standing. This  may  be  done  through  pro- 


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Illinois  Medical  Journal 


fessional  conferences  and  meetings,  case 
presentations,  journals,  exhibits,  and 
through  the  channels  of  radio  and  televi- 
sion. Dissemination  of  this  information 
must  almost  become  a public  duty  at  all 
times. 

Attitudes  of  the  Patient 

How  does  the  patient  feel  about  himself? 
When  asked  to  define,  describe,  or  explain 
epilepsy  one  might  answer,  “I  hate  to  even 
use  the  word,”  “It’s  nasty,”  “It’s  a scar  on 
my  brain,”  “It  can  be  controlled,”  “It  can- 
not be  controlled,”  “I’m  different  than  I 
used  to  be,”  or  “I’m  irritable  and  cranky.” 
Some  would  like  to  become  leaders  in 
their  community  but  fear  that  public  knowl- 
edge of  their  seizures  would  alter  or  jeop- 
ardize their  leadership.  Others  will  tell  their 
employer  about  the  seizures,  but  no  other 
employees.  Others  tell  no  one  at  work  of 
their  plight. 

Because  of  his  seizures,  a patient  may  not 
engage  or  participate  in  the  usual  family 
activities.  In  an  effort  to  “protect”  her  hus- 
band, a wife  will  often  hide  the  fact  of  his 
seizures  from  the  children;  she  might  say, 
“Your  father  has  Ireen  drinking  again,  that 
is  why  I put  him  to  bed.”  Obviously  the 
father  had  just  had  a seizure. 

Many  patients  describe  themselves  at 
work  as  functioning  in  an  atmosphere  of 
continued  fear  that  they  will  be  discov- 
ered and  their  condition  will  be  revealed. 
They  wish  to  get  out  of  sight  when  a seiz- 
ure is  impending.  Others  may  express  the 
fact  that  they  would  be  better  off  in  a new 
job  with  more  money  and  more  responsi- 
bility as  an  excuse  to  leave  a job  once  the 
seizure  state  is  discovered.  This  involves 
additional  stress  and  strain  and  may  cause 
more  seizures  to  appear.  Hence,  they  do  not 
seek  such  jobs,  and  prepare  to  ride  out  one 
storm  in  the  old  place  of  employment. 
Others  will  state  they  would  have  better 
jobs  and  might  have  been  promoted,  but 
they  lost  their  jobs  because  of  their  seizure 
state  being  discovered  one  day  while  at 
work. 

Social  Attitudes 

There  are  many  individuals  with  seizures 
who  are  unable  to  accept  themselves  as 
worthy  individuals  and  under  these  cir- 
cumstances, the  community  is  expected  to 
do  and  feel  the  same.  Some  will  refuse  to 
run  for  public  office  inasmuch  as  they  fear 


they  will  be  judged  harshly  because  of  their 
seizure  state.  Still,  others  are  afraid  to  adopt 
children  because  a social  agency  may  refuse 
or  even  deny  an  application.  Many  will  live 
with  their  feelings  and  find  a place  for 
themselves  in  society  at  their  own  level. 
In  brief,  the  cause  of  these  attitudes  is 
summed  up  in  this  way— what  a patient 
doesn’t  know,  he  fears.  What  people  don’t 
know,  they  fear.  Since  people  know  little 
about  epilepsy,  they  fear  it.  In  the  face  of 
fear  and  hostility  of  the  world,  many  may 
reply  in  kind.  The  problem  must  be  solved 
as  others  have  been— by  making  known  to 
the  people  of  the  community  its  signifi- 
cance. Epileptic  organizations  must  be 
started,  implemented,  and  directed  in  a 
multidisciplined  fashion  to  survey  the  needs 
which  include  diagnosis,  treatment,  edu- 
cation and  eventually  the  employment  of 
people  with  seizures.  These  groups  should 
have  medical  advisory  committees  serving 
as  liaison  with  the  groups  within  the  city. 
By  the  same  token,  there  should  be  edu- 
cational coordinators.  There  are  certain 
areas  in  city  governments  in  which  such 
studies  are  done  regularly  and  routinely 
so  why  not  have  the  same  for  an  epilepsy 
group? 

Public  attitudes  directed  to  the  patient 
who  is  epileptic  must  be  changed  in  many 
communities  and  even  in  certain  states.  It 
is  just  as  important  for  a physician  or  reha- 
bilitation counselor  to  spend  some  time  in 
educating  the  public  as  it  is  to  see  another 
patient  in  his  office  or  in  the  clinic. 

Epilepsy  Program  within 
the  Community 

How  then  does  an  epileptic  program  be- 
gin? Usually  within  a community  there  are 
some  successful  professional  or  businessmen 
who  have  seizures,  or  who  have  someone 
within  their  family  so  affected.  At  first,  only 
a small  group  cadre  is  formed,  but  others 
will  follow  later.  An  example  is  given  of 
40  people  who  appeared  in  Baltimore, 
Maryland,  at  an  initial  meeting  called  by 
a voluntary  agency  on  seizures,  where  it 
was  found  that  39  of  the  charter  group  had 
seizures.  This  is  seen  regularly  and  even 
expected. 

Health  departments  in  counties,  cities, 
and  states  may  be  of  great  help  in  dissemi- 
nating specific  information  about  seizures. 
Often  churches  are  not  included  but  should 
be  involved  for  they  are  excellent  areas 


for  August,  1970 


145 


from  which  to  disseminate  knowledge. 
Community  aspects  vary  with  the  indi- 
vidual’s interest,  but  betterment  of  the 
group  is  found  when  a man  who  has  a dis- 
ability joins  in  with  other  men  who  have 
no  disabilities.  Such  a group  also  helps  pre- 
pare the  disabled  as  a better  citizen. 

Dr.  Raymond  Denneril,  executive  direc- 
tor of  the  Michigan  Epilepsy  Center  says, 
“There  are  no  authorities  in  public  atti- 
tudes in  the  field  of  epilepsy.”  What  exists 
at  present,  he  states,  are  opinions  of  people 
with  varying  types  of  experiences  and  back- 
gi'ouuds.  More  authoritative  research  with 
regard  to  current  attitudes  is  needed  be- 
cause knowledge  grows  with  interest  that 
mounts. 

Management  of  the  Seizure  Patient 

Every  person  with  seizures  who  is  placed 
in  a job  should  be  carefully  selected  and 
realistically  guided  to  include  specific  con- 
tact with  his  employer.  The  vocational 
counselor,  by  spending  a good  deal  more 
time  with  the  individual  with  seizures,  can 
make  him  a far  better  employee.  Unfortu- 
nately, many  epileptics  must  have  jobs  ob- 
tained for  them  because  they  feel  they  are 
poor  candidates  when  employment  is  sought 
individually.  They  feel  that  businessmen 
are  “realistic  people  who  know  all  the 
facts.”  But  many  businessmen  do  hire  such 
paticnt.s,  particularly  if  seizures  are  present 
in  someone  within  their  own  family.  On 
the  other  hand,  the  employer  working  with 
the  epileptic  can  be  a rejecting  factor.  Once 
an  epileptic  is  hired,  he  may  be  protected 
by  others  in  the  plant  or  factory  so  that 
the  employer  will  not  know  about  the 
episodes. 

In  the  recent  past,  there  has  been  dis- 
pelled much  of  the  negative  attitudes 
tow'ard  such  diseases  as  tuberculosis,  heart 
disease  and  syphilis.  Why  not  the  same, 
then,  toward  epilepsy?  Every  negative  and 
positive  attitude  should  be  discussed  with 
every  employer.  When  presenting  the  truth 
to  a prospective  employer,  there  shoidd  be 
no  defensive  attitude.  Presently,  in  several 
cities,  special  lay  groups  have  approached 


many  giants  of  industry  and  have  mobilized 
members  of  medical  advisory  boards  to 
speak  professionally  to  these  executives. 

The  Illinois  Epilepsy  League  is  presently 
embarked  on  such  a campaign.  At  the  same 
time  the  personal  physician  within  the  com- 
munity must  be  knowledgeable  about  the 
individual’s  seizures.  In  other  words,  al- 
though there  are  admittedly,  highly  emo- 
tional problems  existing  in  a patient  with 
seizures,  they  must  be  treated  thoroughly 
within  the  scope  of  the  total  approach. 

With  the  new  impetus  and  the  matter  of 
thorough  diagnosis,  through  examination 
and  management,  there  is  more  and  more 
diminution  in  the  incidence  of  emotional 
presentation.  Ideally,  no  one  with  seizures 
should  be  denied  the  advantage  of  educa- 
tion, the  right  to  marry,  to  beget  children, 
to  drive  a car,  to  hold  public  office,  or 
obtain  insurance,  all  because  he  has  an 
occasional  seizure.  One  should  not  single 
out  a patient  with  epilepsy  as  being  “dif- 
ferent.” Considerable  public  education  is 
then  necessary  to  have  the  individual  with 
seizures  acceiJted  with  the  same  compos- 
ure accorded  to  those  afflicted  with  dia- 
betes, tuberculosis,  heart  trouble  or  cerebral 
palsy.  Severe  restrictions  are  not  necessary 
ill  the  lot  of  the  epileptic  who  carries  his 
heavy  load  anyway. 

The  late  Dr.  William  G.  Lennox  stated, 
“Behind  the  mechanism  of  seizures  lies  the 
subtle  attributes  and  the  vicissitudes  of  each 
individual  epileptic.  To  clarify  remaining 
mystery  about  seizures  and  to  succor  per- 
sons subject  to  them  is  a long-standing  ob- 
ligation that  must  be  redeemed  by  physi- 
cians, brain  scientists,  or  by  men  and  wom- 
en of  good  will.” 

Surely,  the  men  and  women  of  good  will 
exist  in  all  of  our  communities  and  are 
ready  to  play  the  part  in  the  home,  school, 
factory,  office,  camps,  clubs  and  lay  organi- 
zations anywhere.  They  can  be  mobilized 
at  any  time  to  assume  this  obligation,  but 
their  role  must  be  a continuing  one  if  it 
is  to  be  successful.  I'here  can  only  be 
success  with  the  understanding  attitude  of 
the  community  to  the  individual  who  has 
a symptom  called  “epilepsy.” 


Pollution  Control  Spending  Peaks 

Pollution  control  spending  rose  23%  in  1969,  to  a record  of  $256  mil- 
lion among  248  companies,  according  to  a survey  by  the  National  In- 
dustrial Conference  Board. 


146 


Illinois  Medical  Journal 


An  analysis 

Of  500  consecutive  cases 
Of  acute  appendicitis 
In  a metropolitan 
Charity  Hospital 


By  SusHiL  M.  Sethi,  M.D.,  Takayoshi  Matsuda,  M.D.,  L.  Beaty  Pemberton,  M.D., 

AND  E.  Lee  Stroke,  M.D. /Chicago 


Introduction 

Acute  appendicitis  continues  to  demand 
the  surgeon’s  ingenuity  and  judgment,  and 
remains  a significant  cause  of  death,  espe- 
cially in  the  very  old  and  very  young.  Kelly 
and  Watkins^  attributed  the  mortality  of 
acute  appendicitis  to  three  contributing  fac- 
tors: 1)  delay  in  seeking  medical  attention; 
2)  home  treatment  with  laxatives;  and  3) 
difficulty  in  diagnosis.  The  mortality  rate 
from  acute  appendicitis  declined  progres- 
sively from  3%  in  the  middle  1930s  to 
1.92%  between  1937-39,  and  finally  to 
1.48%  during  the  period  1939-45. 

Although  surgeons  have  improved  patient 
care  by  advances  in  sterile  technique,  fluid 
and  electrolyte  replacement,  and  use  of  an- 
tibiotic drugs,  early  surgical  intervention 

From  the  Departments  of  Surgery,  Cook  County 
Hospital,  and  University  of  Illinois,  Chicago  60612. 


remains  the  most  significant  factor  in  main- 
taining a low  mortality  rate  for  acute  ap- 
pendicitis.® During  the  last  two  decades, 
further  progress  has  been  made  in  educat- 
ing the  lay  public  in  regard  to  acute  ap- 
pendicitis, and  in  alerting  physicians  to 
the  need  for  early  diagnosis.®’^  Therefore, 
being  aware  of  these  past  contributions  and 
the  continuing  clinical  problem,  we  decided 
to  study  the  patient  population  of  a charity 
hospital,  with  poor  general  health,  of  the 
low  socio-economic  group,  to  re-assess  the 
present  diagnosis  and  treatment,  as  well  as 
to  review  the  mortality  of  acute  appendi- 
citis in  these  patients. 

Clinical  Material 

The  1964-65  records  of  500  consecutive 
and  unselected  patients  having  acute  ap- 
pendicitis at  Cook  County  Hospital,  Chi- 
cago, were  reviewed.  Patients  with  inciden- 


E.  Lee  Strohl,  M.D.,  (left)  is  clinical  professor  of  surgery  at 
the  University  of  Illinois,  senior  attending  surgeon  at  Presby- 
terian-St.  Luke’s  Hospital,  and  consulting  surgeon  at  Cook  County 
Hospital.  He  is  currently  serving  as  President  of  the  Board  of 
Directors  of  the  Municipal  Tuberculosis  Sanitarium  and  is  the 
immediate  past  president  of  the  Institute  of  Medicine  of  Chicago. 
He  received  his  M.D.  degree  from  the  University  of  Illinois  am' 
s a Fellow  in  Surgery  of  the  Mayo  Foundation.  L.  Beaty  Pem- 
berton, M.D.,  (right)  is  an  instructor  in  surgery  at  the  LIniver 
sity  of  Illinois  College  of  Medicine  and  assistant  attending  sur- 
’’eon  at  Presbyterian-St.  Luke’s  Hospital.  He  is  a specialist  ir 
•gastroenterological  surgery.  Dr.  Pemberton  received  his  M.D.  de- 
Tree  from  Northwestern  University  Medical  School.  Informatior 
on  the  other  authors  is  not  available  since  they  have  returned 
to  their  respective  countries. 


for  August,  1970 


147 


tal  appendectomies  or  normal  appendices 
at  abdominal  exploration  were  excluded 
from  the  study. 

The  greatest  incidence  of  acute  appendi- 
citis occurred  between  the  ages  of  five  and 
ten,  with  almost  half  of  all  the  patients 
between  5 and  15  years  of  age.  There  were 
259  children  and  241  adults,  with  only  42 
patients  over  60  years  of  age.  (Table  1) 

Table  1 


Age  Distribution  of  the  Patients 


Age 

Number  of 

Patients 

Percent 

0-5 

26 

5.2 

5-10 

120 

24.0 

10-15 

113 

22.6 

15-40 

111 

22 .2 

40-60 

88 

17.6 

60-70 

32 

6.4 

70- 

10 

2.0 

Children 

259 

Adults 

241 

Above  50 

Years 

120 

Youngest 

6-inonths-old 

Oldest 

91-vears-old 

Various  symptoms  and  their  duration  are 
tabulated  in  Tables  2 and  3.  Although  a 
majority  of  patients  (62%)  sought  medical 
care  in  the  first  48  hours,  a large  number 
of  patients  (95,  or  19%)  presented  to  the 
hospital  more  than  72  hours  following  the 
onset  of  symptoms.  In  addition,  the  high 


proportion  of  patients  with  pain,  anorexia. 

nausea  and  vomiting,  confirmed  the 

usual 

symptom 

complex  of  this  disease. 

Table  2 

Significant  Syinptonis 

Coiuplainl 

Number  of  Patients  Percent 

Anorexia 

444 

89 

Nausea 

424 

85 

\’omiting 

427 

85 

Pain 

492 

95 

Conslipalion  50 

10 

Diarrhea 

42 

8 

Table  3 

Duration  of  Syniploins 

l ime  (Hours)  Numlter  of  Patients  Percent 

0 12 

56 

1 1.2 

12-24 

185 

37.0 

24-48 

125 

25.0 

48-72 

39 

7.8 

72 -p 

95 

19.0 

The  majority  of  patients  (68%) 

were 

taken  to 

surgery  less  than  six  hours 

after 

admission 

. Only  4%  required  more 

than 

24  hours  of  observation  to  establish  the 


diagnosis.  Furthermore,  while  29%  of  the 
patients  received  two  to  four  liters  of  fluid, 
most  patients  (71%)  were  given  less  than 
one  liter  of  fluid  prior  to  surgery. 

The  management  of  these  500  patients 
demanded  flexibility  in  the  surgical  pro- 


cedure. Although  most  patients  had  general 
anesthesia,  eight  patients  were  operated 
under  spinal  anesthesia,  and  two  with  local 
infiltration.  The  usual  incision  was  the  Mc- 
Arthur-McBurney  muscle-splitting  incision.® 
In  addition,  while  ten  patients  had  drain- 
age for  appendiceal  abscess,  the  other  490 
patients  were  treated  with  appendectomy. 
Following  appendectomy  in  the  patients, 
261  patients  had  no  drainage  or  antibiotic 
drugs;  76  had  subcutaneous  drainage  with 
no  skin  closure,  and  153  received  peritoneal 
drainage. 

The  post-operative  therapy  of  these  pa- 
tients involved  intravenous  fluids,  anti- 
biotic drugs,  nasogastric  intubation,  and 
treatment  of  wound  infections.  Intravenous 
therapy  was  required  in  259  patients  for 
48  hours;  in  168  patients  for  72  hours;  and 
in  73  patients  for  more  than  72  hours.  Anti- 
biotic drugs  were  given  to  157  patients, 
usually  for  perforated  appendices.  Although 
chloramphenicol,  streptomycin  and  other 
broad  spectrum  antibiotic  drugs  were  used, 
penicillin  was  the  most  frequently  em- 
ployed antibiotic  drug.  Nasogastric  intuba- 
tion was  used  in  275  patients  to  treat  or  to 
prevent  abdominal  distention.  Finally,  60 
patients  had  wound  infections  or  intra- 
abdominal abscesses  which  required  subse- 
quent drainage. 

The  final  pathological  report  was  as  fol- 
lows: acute  appendicitis  without  perfora- 
tion in  323  patients,  and  acute  appendicitis 
with  perforation  in  167  patients.  The  ten 
patients  with  appendiceal  abscess  had  no 
report  because  the  appendix  was  not  re- 
moved. 

The  average  hospital  stay  was  6.8  days. 
Nevertheless,  163  patients  required  ten  or 
more  days  of  hospitalization  for  associated 
medical  problems  or  post-operative  conqrli- 
cations. 

The  mortality  was  eight  deaths  out  of 
500  patients,  or  1.6%.  All  deaths  occurred 
in  adults.  After  searching  our  records,  we 
found  that  the  last  death  in  a child  from 
acute  appendicitis,  at  Cook  County  Hos- 
pital, Chicago,  occurred  in  1961.  The  cause 
of  death  in  the  ei'>ht  oatients  who  died, 
was  overwhelming  sepsis  in  four  patients, 
and  one  patient  each  with  acute  renal  fail- 
ure, upper  gastrointestinal  bleeding  and 
hepatic  failure,  massive  upper  gastrointes- 
tinal bleeding,  and  pulmonary  infarction. 

Further  analysis  of  the  deaths  revealed 
that  six  of  the  eight  deaths  occurred  in  120 


14H 


Illinois  Medical  Journal 


patients  over  50  years  of  age,  a mortality 
rate  of  5%.  (Table  4)  Four  deaths  occurred 
in  the  42  patients  over  the  age  of  60,  for 
a mortality  rate  of  9.5%.  On  the  contrary, 
the  mortality  rate  in  patients  below  the  age 
of  50  was  0.52%. 

Table  4 

Analysis  of  Deaths  (Total  Number:  8) 

1 —Race  and  Sex 

Negro  Male  2 

Negro  Female  3 

White  Male  2 

Spanish  Male  1 

2— Age 

70  years  and  older  4 
50-60  years  2 

40  years  1 

20  years  1 

3—  Duration  of  symptoms  prior  to  admission 

24-48  hours  4 

48-72  hours  1 

More  than  72  hours  3 

4—  Cause  of  death 

Generalized  peritonitis  with  overwhelming  sepsis  4 

Acute  renal  failure  1 

Pulmonary  infarct  1 

Hepatic  failtire,  ascites  and  upper  GI  bleeding  I 

Massive  upper  GI  bleeding  1 

Discussion 

In  spite  of  improved  education  of  the 
lay  public,  many  patients  had  a long  delay 
between  the  onset  of  symptoms  and  arrival 
at  the  hospital.  Such  a delay  increases  the 
number  of  ruptured  appendices  and  deaths. 
All  of  our  deaths  occurred  in  patients  who 
were  admitted  to  the  hospital  more  than 
24  hours  following  the  onset  of  symptoms. 
Five  of  the  eight  deaths  occurred  in  pa- 
tients admitted  between  24  and  48  hours 
after  the  onset  of  symptoms,  and  the  re- 
maining three  deaths  occurred  in  patients 
admitted  alter  more  than  72  hours  of 
symptoms. 

In  those  patients  who  present  in  the  late 
stage  of  the  disease,  careful  assessment  and 
optimal  pre-operative  restoration  of  cardio- 
pulmonary, hemodynamic  and  renal  func- 
tion is  mandatory  in  successful  surgical 
therapy.  Management  of  hydration  is  a chal- 
lenge in  some  patients,  such  as  those  with 
congestive  heart  failure,  or  cirrhosis  with 
ascites. 

An  early  diagnosis  which  leads  to  prompt 
surgical  intervention  is  essential  for  effec- 
tive management  of  acute  appendicitis. 
Confirming  the  diagnosis  of  appendicitis  is 
not  easy  in  atypical  cases.  In  our  patients, 
pelvic  inflammatory  disease  was  a most  per- 
plexing problem  in  young  females.  Various 
laboratory  adjuncts,  such  as  white  cell 
count,  urinalysis,  and  abdominal  X-rays, 


were  sometimes  helpful,  but  there  was  no 
single  definite  diagnostic  test  for  acute  ap- 
pendicitis. In  our  experience,  careful  ob- 
servation with  frequent  re-examination  of 
the  abdomen  is  the  most  important  diag- 
nostic tool. 

The  value  of  antibiotic  drugs  in  manag- 
ing acute  appendicitis  and  its  complications 
is  difficult  to  evaluate.  While  three  of  the 
eight  patients  who  died  in  this  series  re- 
ceived pre-operative  antibiotic  drugs,  all 
of  these  patients  received  these  drugs  in  the 
post-operative  period.  Overwhelming  sepsis 
accounted  for  half  of  the  deaths  in  this 
study.  Thus,  on  a theoretical  basis,  some 
of  the  newer  broad  spectrum  antibiotic 
drugs  that  are  particularly  effective  against 
gram  negative  and  anaerobic  bacteria 
shoidd  improve  the  treatment  of  infections 
secondary  to  appendicitis. 

Summary  and  Conclusions 
In  spite  of  education  of  the  lay  jjublic 
and  advances  in  surgical  management,  the 
mortality  of  acute  appendicitis  remains 
comparatively  high,i®  especially  in  elderly 
patients.  Five  hundred  (500)  consecutive 
patients  with  acute  appendicitis,  at  Cook 
County  Hospital,  Chicago,  during  1964-65, 
have  been  reviewed  in  an  attempt  to  re- 
evaluate present  treatment,  as  well  as  to 
review  the  mortality  of  this  disease  in  a 
charity  hospital.  An  overall  mortality  of 
1.6%  was  observed.  There  were  no  deaths 
in  children.  However,  a 5%  mortality  was 
found  in  patients  over  the  age  of  50  years, 
and  9.5%  over  the  age  of  60.  Most  of  the 
deaths  occurred  in  patients  with  ruptured 
appendices  who  presented  in  a late  stage 
of  the  disease.  A more  aggressive  approach 
to  the  surgical  management  of  acute  appen- 
dicitis should  improve  the  overall  mortality 
rate.  ◄ 

References 

1.  Kelly,  F.  R..  and  Watkins,  R.  M.;  “Ajiiiendi- 
dtis  in  Adults,”  J.A.M.A.,  112:1785.  1939. 

2.  Strohl,  E.  Lee:  “Acute  Appendicitis:  Analysis 

of  the  Records  of  300  Cases,”  74:171 

(August)  1938. 

3.  Strohl,  E.  Lee:  ■‘.-\ppendectomy  by  the  Muscle- 
Splitting  Technic,”  S,  Clin.  No.  Am.,  22:1  (Feb- 
ruary) 1942. 

4.  Strohl,  E.  Lee,  and  Sarver,  F.  E.:  ".Acute  .Ap- 
pendicitis: An  Analysis  of  Eight  Hundred  Sev- 
enty-Eight Cases  at  St.  Luke’s  Hospital,  Chi- 
cago,” Arch.  Surg.,  55:1  (November)  1947. 

5.  Rowe,  M.  L:  “Diagnosis  and  Treatment:  yAp- 
pendicitis  in  Childhood,”  Pediat.,  38:1067,  1966. 

6.  Bower,  J.  O.:  “The  Mortality  of  Acute  .Appen- 
dicitis,” J.A.M.A.,  99:1765,  1932. 

(Continued  on  page  17S) 


{or  AugusI,  1970 


149 


June  15,  1970 

Gentlemen : 

I talked  with  someone  in  your  organization 
on  the  phone  Friday  about  an  article  on  Hodg- 
kin’s disease  that  I wanted  to  get  a reprint  of, 
and  it  arrived  at  my  home  Saturday  Special 
Delivery. 

Thanks  very  much  for  this  prompt  and  ex- 
cellent response. 

Sincerely, 

W.  J.  Wichman 

April  22,  1970 

Dear  Dr.  Van  Dellen: 

The  article  “What  Generation  Gap”?  (IMJ,  Feb. 
1970,  Vol.  137,  No.  2,  pages  168-171)  prompts  the 
following.  Dr.  Eisele’s  interpretation  seems  to  be 
contrary,  in  some  instances,  with  the  survey  data. 
Also,  the  construction  of  the  questions  does  not 
appear  to  be  an  entirely  impartial  approach  to  the 
subject. 

However  based  on  the  questionnaire  used  and 
the  responses,  I could  not  resist  writing  the  way 
it  looks  to  me. 

Sincerely, 

Alfred  W.  Hubbard 
Director  of  Research 
Modern  Medicine 

The  Illinois  Medical  Journal  survey  of  attitudes 
and  opinions  of  established  practicing  physicians, 
students,  interns,  and  residents  indicates  that  there 
is  little  medical  generation  gap.  There  is  a reason- 
ably good  agreement  between  the  future  doctors 
and  the  established  doctors  on  subjects  relating  to 
medical  proficiency,  relicensing,  and  so  on.  But. 
on  socio-medical  issues  the  generation  gap  is  sub- 
stantial and  readily  apparent. 

When  one-fifth  to  lh' ee-fonrths  or  more  of  the 
future  doctors  disagree  with  the  established  doctors 
on  some  important  items,  then  the  medical  profes- 
sion do"=  a cp-.'oi’=  o n rcTon  gap.  Jt  would 

appear  that  this  substantial  proportion  of  America’s 
futuie  do'^to'”  r=rll\  is  hont  on  revolutionizing 
the  socio-medical  aspects  of  health  care.  The  shout 
of  this  large  percentage  of  future  doctors  is  really 
an  imposingly  demanding  voice  of  the  future  phy- 
sician. 

Nearly  three-fourths  f+71%)  more  of  interns 
and  residents  and  about  double  the  proportion 
(+92%)  more  students  than  established  physi- 
cians favor  the  hiring  of  trained  and  licensed  “doc- 
tor’s assistants”  or  “feldshers”  to  work  in  his  of- 


Ed. note:  Membership  Forum  is  a means  for 

the  ISMS  physician  to  express  opinion  and  view^ 
point  on  varied  topics.  If  you  have  an  item  you 
would  like  brought  before  your  fellow  practitioners, 
please  submit  it  to  Membership  Forum,  Illinois 
State  Medical  Society,  360  N.  Michigan  Ave.,  Chi’ 
cago  60601.  Communications  should  not  exceed 
250  words.  The  right  to  abstract  or  edit  is  re’ 
served.  Names  will  be  withheld  upon  request,  but 
anonymous  letters  will  not  be  accepted. 


fice,  performing  such  tasks  as  preliminary  screen- 
ing for  illness,  well-baby  examination,  and  family 
planning. 

Two-fifths  ( +43%)  of  interns  and  residents, 
and  over  one-half  (+54%)  more  students  than 
established  doctors  favor  having  the  state  medical 
society  lend  financial  support  to  the  establishment 
of  health  centers  in  deprived  areas. 

Survey  respondents  feel  that  interns  and  residents 
should  supply  the  manpower  in  health  centers  by 
four-fifths  of  the  established  doctors  to  only  one- 
fifth  of  future  doctors.  Among  interns  and  residents, 
there  are  nearly  one-fifth  fewer  who  agree  with 
this,  or,  a two-thirds  to  one-third  proportion.  Among 
students  it  is  8%  fewer  or  three-fourths  to  one- 
fourth  who  agree  with  the  established. 

Only  one  out  of  ten  students  and  nearly  two  out 
cf  ten  intf>rns  and  residents  disagree  with  the  prop- 
osition that  the  ISMS  should  initiate  an  educa- 
tional campaign  to  liberalize  therapeutic  abortion. 
It  is  nearly  one  out  of  four  for  the  older  doctor 
of  8%  more  interns  and  residents  and  17%  more 
of  the  students  than  established  feel  the  law  should 
be  liberalized.  Nearly  the  same  ratios  are  evident 
in  the  case  of  legislation  providing  medical  care 
for  arrested  chronic  alcoholics  as  a medical  problem. 

An  examination  of  the  situation  for  other  prop- 
rsitii'tis  will  reveal  fu’ther  differences.  However,  it 
can  be  noted  that  both  the  future  doctors  and  the 
older  established  doctors  appear  to  close  ranks  when 
it  ccmes  to  questions  on  qualifications,  proficiency, 
discipline,  postgraduate  education,  relicensing,  or 
the  “medical”  oriented  subjects.  There  is  very  little 
medical  generation  gap  in  the  approach  to  thinking 
by  either. 

It  is  not  so  much  a “medical”  generation  gap  as 
it  is  a “social  consciousness”  gap  between  the 
youth  of  the  future  doctor  and  the  age  of  the 
established  doctor.  The  medical  establishment  can- 
not simply  shrug  it  off.  The  message  the  medical 


150 


Illinois  Medical  Journal 


youth  generation  is  putting  forth  is  that  things  are 
changing.  The  establishment  had  better  “get  with 
it,”  think,  plan,  and  do  more  in  social  medical 
assistance  for  the  sick-deprived. 

To  interpret  what  the  youth — future  doctors — 
are  saying  is:  the  physician  has  responsibilities  as 
an  educated  person  aside  from  his  role  as  a phy- 
sician. He  should  participate  in  the  total  social,  cul- 
tural, educational,  and  health  life  of  the  com- 
munity. 

As  a physician  he  has  a special  area  of  responsi- 
bility to  know  the  health  needs  of  his  own  com- 
munity. He  should  be  willing  to  plow  back  some 
of  his  income  via  the  medical  society  dues  and 


assessments  to  improve  standards  of  public  health. 
He  must  exert  pressure  for  health  centers  for  the 
deprived.  He  must  stand  up  and  be  counted  for 
improvement  in  the  quality  of  local  nursing  homes. 
Also  in  addition  to  his  immediate  responsibility  to 
his  own  local  community,  the  physician  is  now 
obliged  to  become  knowledgeable  and  active  in  tbe 
broader  aspects  of  national  involvement  in  health 
care.  It  is  also  the  physician’s  responsibility  to 
look  to  the  future  and  anticipate  health  needs  at 
both  local  and  national  levels. 

There  is,  indeed,  a generation  gap  between  the 
future  and  established  doctors.  This  gap  chiefly 
concerns  social  consciousness.  AWH 


Medical  Controversy 

The  principal  conclusion  from  events  of  this  post  year  is  that  medical 
students  are  strong-willed;  some  are  able  to  spend  large  amounts  of 
time  on  extra-curricular  concerns  and  still  keep  their  academic  work  up 
to  par.  They  are  imbued  with  an  immense  social  consciousness  (far  greater 
than  most  of  us  at  that  age),  and  many  of  them,  whether  silent  or  noisy, 
minority  or  majority,  want  to  help.  If  action  and  protest  are  to  assist  the 
medical  mission  to  the  sick,  they  must  address  themselves  to  at  least  one 
of  the  major  problems  that  obstruct  that  mission  today.  Although  it  would 
be  presumptuous  for  any  one  doctor  to  catalogue  all  the  ills  of  medicine, 
or  recommend  treatment,  the  following  is  a list  of  10  major  concerns  in 
1970: 

Care  of  the  Sick 

1) .  Facilitate  energy  into  the  system  for  all  who  need  it. 

2) .  Lower  the  cost  of  service  by  increasing  efficiency,  improving  admin- 
istration and  decreasing  waste. 

3) .  Arrange  payment  so  that  the  patient  is  not  penalized  for  the  severity 
of  his  illness,  over  which  he  has  no  control. 

Education  of  the  Physician 

4) .  Shorten  the  duration  of  medical  education  (college  to  practice)  by 
one,  two,  or  three  years. 

5) .  Remodel  the  curriculum  so  that  career-patterns  can  determine  content 
and  courses  are  relevant  to  need,  yet  without  premature  specialization. 

6) .  Lower  the  cost  by  new  teaching  methods;  meet  those  costs  by  a merit 
scholarship  system  attracting  talent  without  penalizing  poverty. 

7) .  Expand  the  content  of  medical  education  so  that  a new  generation 
of  more  able  physician-administrators  will  improve  rather  than  merely 
deplore  the  cost  and  delivery-systems  of  American  medicine. 

Biomedical  Research 

8) .  Expand  objectives  of  medical  research  to  include  a rigorous  study 
of  social  goals  and  delivery  systems. 

9) .  Initiate  a more  rigorous  quality  control,  with  better  selection  of  re- 
cipients for  the  tax-based  research  support. 

10) .  Expand  the  sources  of  research  support  to  tap  all  segments  of  so- 
ciety and  all  political  units.  (Francis  D.  Moore:  West  of  Francis  Street— Can 
Student  Pressures  Assist  the  Medical  Mission?,  New  England  Jl.  Med. 
282:18  (Apr.  30)  1970,  pg.  1008-1013.) 


for  August,  1970 


151 


Contributions  to  Clinical  Neuropsychol- 
ogy. Edited  by  Arthur  L.  Benton,  Aldine 
Publishing  Company,  Chicago.  1969;  243 
pages,  several  tables. 

This  small  volume  provides  a concise, 
definitive,  up-to-date  compendium  of  pres- 
ent information  on  clinical  neuropsychol- 
ogy, which  is  relatively  a new  science  not 
more  than  20  years  old.  This  discipline  uti- 
lizes clinical  research  studies  and  animal  ex- 
perimentation together  with  developmental 
observations  to  lulfill  its  purpose  of  defin- 
ing the  relationship  between  brain  func- 
tion and  human  behavior.  Obviously,  quite 
a number,  as  well  as  a variation  of  scien- 
tific areas,  must  be  present  within  this  aegis. 

Some  eight  authorities,  each  versed  in 
his  special  area  of  Neuropsychology  discuss 
their  specific  contributions  to  this  little 
volume.  The  chapters  are  entitled  1.  Mod- 
ern Trends  in  Neurojisychology,  2.  The  Be- 
havioral Effects  of  Commissural  Section,  3. 
Neuropsychological  Studies  of  the  Phantom, 
4.  Problems  in  the  Anatomical  Understand- 
ing of  the  Aphasias,  5.  Constructional 
Apraxia:  Some  Unanswered  Questions,  6. 
Protopathic  and  Epicritic  Sensation:  A Re- 
appraisal and  7.  .Auditory  Agnesia:  A Re- 
view and  Report  of  Recent  Evidence.  Each 
of  these  subject  titles  is  geared  to  its  rela- 
tionship to  behavioral  syndromes,  which  are 
the  end  products,  clinically. 

This  book  holds  great  value  lor,  and  is 
indeed  a useful  tool  to,  the  Clinical  Neu- 
rologist in  the  adult  or  childhood  field,  for 
the  psychiatrist  to  adults  or  to  children,  to 
speech  therapist,  to  the  physical,  occupa- 
tional, and  play  therapist.  The  material  is 
so  well  structured  and  constructed  and  so 
easy  to  read  and  tomprehend  in  the  areas 
of  aphasia,  apraxia,  agnosia,  dyslexia, 
language  retardation,  that  it  can  be  easily 
utilized  by  these  disciplines.  Eiually,  an  ex- 
cellent set  of  tables  in  each  chapter,  with 
a more  than  adequate  Reference  List,  at 
the  end  of  the  book,  more  than  enhances 
its  usable  values. 

Louis  Boshes,  M.D. 


The  Pulivionary  Circulation  and  Inter- 
stitial Space.  Alfred  P.  Eishman  and 
Hans  H.  Hecht,  432  pages,  illustrated. 
■|15.00.  London  and  Chicago:  The  Uni- 
versity of  Chicago  Press,  1969. 

This  volume  on  the  pulmonary  circula- 
tion and  interstitial  space  is  an  outgrowth 
of  the  Satellite  Conference  in  the  Pulmon- 
ary Circulation  held  in  Chicago  in  the 
Eall  of  1968.  Outstanding  investigators 
presented  and  assessed  the  current  status 
of  the  knowledge  of  the  pulmonary  circula- 
tion and  the  interstitial  space.  The  manu- 
script and  discussions  presented  at  the  con- 
ference comprise  the  volume. 

There  are  four  sections:  1)  pulmonary 
alveolar-capillary  interface  and  interstitium, 
2)  vasomotion  and  electrophysiology  of 
smooth  muscle,  3)  regulation  of  pulmonary 
circulation  and,  4)  pidmonary  hemodynam- 
ics. 

The  contributors  represent  physiologists 
interested  primarily  in  the  pulmonary  cir- 
culation, as  w'ell  as  those  interested  in  mus- 
cle physiology,  bioengineering,  transcapil- 
lary exchange,  etc.  so  that  good  interdiscip- 
linary interchange  is  represented.  Through- 
out, strticture  is  related  to  function  and 
to  the  new'er  concepts  in  the  various  fields. 

The  volume  itself  is  handsomely  pro- 
duced and  the  illustrations  and  charts  are 
of  the  highest  caliber.  Unfortunately,  the 
test  material  and  its  presentation  are  so 
sophisticated  that  only  a limited  audience 
will  appreciate  its  value.  As  a consequence, 
it  will  exist  essentially  as  a reference 
volume  for  those  interested  in  the  basic 
physiologic  aspects  of  the  pulmonary  cir- 
culation. 

Thomas  W.  Shields,  M.D. 

Cardiovascular  Surgery,  Current  Prac- 
tice. Edited  by  Thomas  H.  Burford  and 
4'homas  B.  Eerguson. 

This  well  constructed  book  of  250  pages 
is  organized  in  a very  logical  form,  where- 
by the  earlier  chapters  are  discussions  of 
general  topics  which  include  Chapter  1, 


l.")2 


Illinois  Medical  louuial 


whole-body  perlusion  and  in  Chapter  2,  the 
over  all  postoperative  care  of  the  open- 
heart  patient.  Chapter  3 is  a supplement  to 
the  second  chapter  on  postoperative  care, 
dealing  primarily  with  respiratory  support. 
These  three  chapters  of  the  book  are  ex- 
ceedingly enlightening,  and  would  be  an 
excellent  fundamental  background  for  any 
surgical  resident,  and  especially  a surgical 
resident  who  plans  to  perform  cardiothor- 
acic  surgery.  If  the  book  contained  only 
these  three  chapters,  it  would  be  a worth- 
while addition  to  any  surgical  library. 

The  fourth  chapter,  which  deals  pri- 
marily with  tetralogy  of  Fallot,  is  an  ex- 
cellent chapter  on  this  particular  congeni- 
tal anomaly.  However,  I believe  it  presents 
the  weakest  link  of  the  book  in  the  respect 
that  there  is  no  consideration  given  to  the 
remainder  of  the  problem  of  congenital 
heart  disease  and  its  surgical  treatment  in 
the  neonatal  and  infancy.  The  text  then 
does  have  a void  in  the  current  practice 
of  cardiovascular  problems  in  infants  and 
children,  excluding  the  tetralogy  of  Fallot. 

The  following  two  chapters  which  cover 
the  problem  of  valvidar  surgery  are  very 


informative,  well  organized  and  cover  both 
the  prosthetic  valves,  as  well  as  homografts. 
The  chapter  on  myocardial  revasculariza- 
tion is  likewise  informative  and  outlines  the 
historical  background  of  coronary  artery 
surgery  and  brings  it  up  to  date,  with  the 
closing  portion  of  the  chapter  suggesting 
that  the  results  of  coronary  artery  surgery 
are  still  incomplete  because  of  short  fol- 
low-up and  that  further  development  along 
the  lines  of  vein  bypass  may  or  may  not 
prove  to  be  more  productive. 

The  final  chapters  on  cardiac  transplan- 
tation and  left  ventricular  assist  devices  are 
both  interesting  and  informative.  The  ap- 
plication of  cardiac  transplantation  is  per- 
haps somewhat  optimistic,  but  certainly  de- 
serves further  inspection  and  continued  re- 
search. Likewise,  the  chapter  on  ventricular 
assist  devices  is  somewhat  restricted  and  uni- 
lateral, but  is  a good  introduction  to  the 
entire  problem  of  ventricular  assists  and 
its  role  in  cardiac  surgery. 

In  reviewing  this  book  I have  found  it 
most  stimulating  to  read,  easy  to  read,  and 
w'ould  consider  it  a real  asset  to  the  sur- 
gical library  in  any  training  institution. 

Arthur  DeBoer,  M.D.,  S.C. 


Man,  A Howling  Monkey? 

Man  probably  descended  from  a primate  that  used  its  limbs  for  grasp- 
ing and  hanging  in  much  the  same  way  that  the  South  American  howling 
monkey  (Alouatta  palliata)  now  does,  according  to  Jack  T.  Stern,  Jr., 
instructor  of  anatomy,  in  The  Pritzker  School  of  Medicine  at  The  Uni- 
versity of  Chicago. 

Stern's  theory  is  based  on  the  fact  that  the  muscle  structure  and  bone- 
muscle  relationships  of  the  human  hip  are  more  similar  to  the  hip  of  the 
howler  than  to  the  hip  structures  of  any  other  type  of  primate. 

"Man  probably  evolved  from  a species  that  was  physically  ready  to 
walk  on  the  ground,"  Stern  said.  "The  hip  musculature  of  evolving  man 
would  have  required  the  least  reorganization  had  he  descended  from  a 
primate  employing  its  hind  limbs  for  slow  climbing  and  suspension  as 
does  the  howler. 

"Since  there  is  a direct  relationship  between  the  structure  of  an  animal's 
limbs  and  its  method  of  locomotion,  the  logical  way  to  hypothesize  about 
'preman's'  style  of  movement  is  to  observe  the  movements  of  the  tree 
dwelling  primate  with  muscular  and  skeletal  structures  most  similar  to 
those  of  man,"  he  said. 

The  examination  of  18  species  of  South  American  monkeys  and  speci- 
mens of  several  kinds  of  Old  World  primates  revealed  that  the  species 
with  a hip  structure  most  like  modern  man  is  the  howling  monkey. 

This  does  not  mean,  however,  that  the  howler  is  an  ancestor  of  man. 
Stern  emphasized.  All  evidence  indicates  that  the  South  American  primates 
were  separated  from  the  Old  World  primates,  from  which  man  evolved, 
between  40  and  50  million  years  ago— long  before  man  appeared. 

"Furthermore,  the  howling  monkey  has  a prehensile  tail.  Man  more 
likely  evolved  from  a primate  with  a reduced  or  absent  tail. 


tor  August,  1970 


153 


Illinois  adopts  Anatomical  Gift  Act 


By  Frank  Pfeifer^  ISMS  Legal  Council/Springfield 


Illinois  has  adopted  a new  Anatomical 
Gift  Act  which,  while  differing  somewhat 
from  the  Uniform  Act  on  this  subject,  is 
a great  improvement  over  the  one  previous- 
ly in  force. 

Under  this  Act,  which  is  set  out  in  Para- 
graphs 551  through  561  of  Chapter  3,  Illi- 
nois Revised  Statutes,  1969,  the  gift  of  all 
or  any  part  of  the  body  may  be  made  by 
the  donor  during  his  lifetime  or  by  his  next 
of  kin  after  his  death.  In  the  case  of  the 
gift  by  the  living  donor,  the  document  mak- 
ing the  disposition  of  all  or  any  part  of 
the  body  must  be  signed  in  the  presence  of 


two  witnesses,  in  much  the  same  manner 
as  a will  is  executed. 

The  American  Medical  Association  has 
a form  to  be  used  by  the  living  donor  un- 
der the  Uniform  Act  but  this  form  is  not 
legal  in  Illinois  and  therefore  should  not 
be  used  by  any  resident  of  Illinois. 

The  Illinois  State  Medical  Society  and 
the  Illinois  Hospital  Association,  after  the 
adoption  of  this  new  Act,  which  repealed 
the  old  Act  on  this  subject,  devised  forms 
for  both  types  of  gifts,  together  with  in- 
structions as  to  the  manner  of  filling  out 
the  forms,  copies  of  which  are  as  follows: 


(1) 

I,  

(2) 


(3) 


(4) 

purpose:  


Anatomical  Gift 
By  a Living  Donor 


do  hereby  give 

to 

for  the  following 


IN  WITNF.SS  VV'HEREOF.  I have  hereunto  set  tnv  hand 

(■''.) 

and  seal  this  day  of  , A D.  19 

(fi) 

(SEAL) 

Signed,  sealed,  published  and  declared  hv  the  said 

(I) 

in  the  presence  of  us. 

who  at  his  (her)  retpiest,  in  his  (her)  presence  and  in 
the  jtresence  of  each  other  have  hereunto  subscribed  our 
names  as  attesting  witnesses,  believing  him  (her)  to  be  of 
sound  atid  disposing  mind  and  memory,  free  from  anv 
undue  influence,  and  to  ktiow  the  olijects  of  his  (her) 
hountv  and  affection. 

0) 


(7) 


Instructions 

1.  Insert  name  of  jrerson  making  gift. 

2.  Insert:  “mv  whole  bodv”:  or  list  specific  orgatis  and 
parts  to  he  given. 

3.  Insert  name  and  addre.ss  of  a physician;  or  a hos- 
pital, or  a medical  institution  to  receive  the  gift. 

1.  Insert:  “anv  purpose  authorized  bv  law:”  or  “a  trans- 
plantation” or  "therapy;”  or  “research;”  or  “medical 
education.” 

5.  Insert  date  of  the  signing  of  this  card. 

6.  Signature  of  donor. 

7.  Signature  and  address  of  two  necessary  witnesses. 

Anatomical  Gift  by  Next  of  Kin 
Or  Other  Authorized  Person 

I.  I (we)  are  the  surviving: 

1.  □ Spouse  and  adult  sons  and  daughters 

2.  n lloth  parents  or  surviving  parent 


,3.  □ Adult  brothers  and  sisters 

4.  □ Guardian  of  the  persoti  of  the  decedent 
.5.  □ Person  authorized  or  under  obligation  to 
dispose  of  the  body 

of  who  died  on  the 

day  of  , 19 in  the  County 

of  , State  of  : 

and 

II.  I (we)  hereby  give: 

□ The  entire  body  of  the  deceased. 

Q Anv  specific  organs  or  parts  of  the  body  of  the 
deceased  designated  by  the  donee. 

□ The  following  organs  or  parts  of  the  body  of 
the  deceased: 


TO:  

(Insert  name  and  address  of  a jthysidan;  a hos- 
]tital;  or  a medical  institution) 
for  one  of  the  following  purposes: 

□ .\ny  purpose  authorized  by  law. 

fyi  .\  transplantation. 

□ Therapy. 

□ Research. 

□ Medical  education. 

III.  I (we)  hereby  represent  and  certify  that  I (we)  are 
the  person  (.s)  authorized  to  execute  this  authoriza- 
tion in  accordance  with  the  order  of  priority  speci- 
fied in  the  Elniform  Anatomical  Gift  Act  as  listed 
in  jj^I  aliove. 

Name  Relationship  to  deceased  City  & State 


Instructions 

This  form  must  be  signed  fry  the  survivor  or  survivors 
in  the  order  of  priority.  Nos,  1 through  5,  with  all  per- 
sons in  anv  category  lieing  rec|uired  to  sign,  (EXAMPLE: 
Eorm  to  he  signed  bv  living  spouse  and  all  living  adult 
sons  and  daughters;  but  if  no  survivors  in  this  category, 
then  go  to  No.  2 under  which  surviving  parents  or  parent 
must  sign  Init  if  no  one  in  this  category,  go  to  No.  3, 
where  all  surviving  brothers  and  sisters  must  sign;  and 
in  the  same  manner  through  Categories  4 and  5 if  neces- 
sary.) 

If  additional  signature  lines  are  needed,  they  may  be 
added  at  the  bottom  of  the  form. 


154 


Illinois  Medical  Journal 


PROGRAMMING  THE  MEDICAL  COMPUTER 


There  is  considerable  difference  between 
the  interpretation  of  medical  terms  by  the 
physician  and  bis  patients.  Charles  M. 
Boyled  a bnal  year  student,  University  of 
Cdasgow,  prepared  two  multiple  choice 
questionnaires  that  included  such  common- 
ly used  terms  as  arthritis,  heartburn,  palpi- 
tation, stomach,  and  kidneys.  The  ques- 
tionnaires were  completed  by  234  out-pa- 
tients and  compared  with  those  conqdetcd 
l)y  35  physicians. 

“The  doctors  were  unanimous  in  their 
choice  of  dehnition  for  7 of  the  12  terms— 
‘arthritis,’  ‘heartburn,’  ‘jaundice,’  ‘palpita- 
tion,’ ‘bronchitis,’  ‘piles,’  and  ‘flatidence.’ 
They  reached  a level  of  agreement  of  over 
90%  for  ‘least  starchy  lood,’  ‘a  medicine,’ 
and  ‘a  good  appetite.’  ‘Constipation’  was 
debited  as  ‘not  opening  one’s  bowels  every 
day’  by  11.4%  and  ‘diarrhea’  as  ‘passing 
a lot  of  bowel  motions  in  a short  time’  by 
31.4%.  The  very  low  level  of  agreement  in 
this  case  may  have  been  dtie  to  poor  word- 
ing of  alternative  definitions. 

“The  patients  did  not  reach  complete 
agreement  of  dehnition  for  any  term.  By 
comparison  with  the  ‘majority  doctors’  deb- 
nition,’  between  80  and  90%  of  patients 
answered  ‘a  good  appetite,’  ‘arthritis,’ 
‘heartburn,’  and  ‘bronchitis’  correctly. 
About  three-cpiarters  correctly  defined 


‘janndice,’  ‘least  starchy  food,’  and  ‘piles,’ 
while  only  50  to  00%  agreed  wilh  the  ma- 
jority of  doctors  for  ‘constipation’  and 
‘palpitation.’  The  lowest  responses  lor  cor- 
rect definition  of  terms  were  for  ‘a  medi- 
cine’ (43.2%),  ‘flatulence’  (42.9%),  and 
‘diarrhea’  (37.0%).  Patients  disjilayed  a 
considerable  lack  of  knowledge  ol  simple 
anatomy,  the  best  understood  terms  being 
‘intestines’  (70.9%)  and  ‘thyroid  gland’ 
(09.9%),  and  the  poorest  ‘heart’  (42.1%) 
and  ‘stomach’  (20.2%,).’’ 

1 his  study  in  semantics  was  aimed  main- 
ly at  the  future  use  of  the  computer  in 
diagnosis,  ft  is  mamlatory  that  we  have  a 
vocabulary  of  medical  terminology  that  is 
less  amhiguons  or  more  limited  and  prac- 
tical. Education  must  also  he  considered  as 
there  is  a debnite  relationship  between 
vocabulary  performance  and  scholastic  at- 
tainment of  the  patient.  We  must  also 
recognize  the  fact  that  there  arc  large  areas 
of  misunderstanding  between  conventional 
medical  opinion  and  the  erratic  notions  of 
the  lay  mind. 

T.  R.  Van  Dellen,  M.D. 

Referenoe 

I.  Charles  ^^ullay  Boyle:  “Difteience  between 

I’aticnt’s  and  Doctors'  Inlei pretalion  of  .Some 
Common  ^[edical  Terms,"  British  Medical 
Journal  (May  2)  1970,  pages  286-289. 


Slaughter  on  the  Highways 


Fund-raising  organizations  across  the  na- 
tion cheer  wildly  when  they  achieve  their 
goal  or  set  a new  record.  We  have  set  a 
new  record  on  America’s  highways  . . . not 
the  kind  to  cheer  about— but  the  kind  that 
should  call  for  a great  public  reaction. 


More  than  56,500  persons  were  killed  in 
highway  accidents  in  1969— the  highest 
nnmber  in  history.  And,  more  than  4,700,- 
000  men,  women  and  children  were  injured 
last  year,  dliat’s  a lot  of  pain  and  suffering 
—but  it  doesn’t  seem  to  stop  the  slaughter. 


for  August,  1970 


159 


VVe  react  with  apathy. 

56,500  killed,  4,700,000  injured.  These 
numbers  may  be  over  your  head.  It  they 
don’t  hit  where  you  live— and  drive— you 
might  try  to  recall  whether  an  acquaint- 
ance, a triend  or  a relative  was  in  a traffic 
accident  in  ’69.  He  didn’t  get  a scratch?  He 
was  lucky.  Nearly  5 million  men,  women 
and  children  were  not  that  lucky. 

In  The  Travelers  Insurance  Co.’s  annual 


booklet  of  highway  accident  data,  a com- 
parison ot  specific  types  of  accidents  in  1969, 
with  those  during  1968,  reveals  a 15% 
increase  in  single-car  accidents.  Once  again 
the  accelerator  was  the  big  gun.  Whether  it 
was  a muscle  car  with  the  enticing  name  of 
a beast  of  prey  or  a ten-year-old  clunker, 
there  was  a human  foot  on  every  pedal. 

It  seems  clear  that  drivers  continue  to  be 
the  ultimate  culprits.  X. 


ILLINOIS 

MEDICAL 

ASSISTANTS 

ASSOCIATION 


REPORT 


40-hour-week:  myth  for  Medical  Assistants 


By  Ruby  Jackson/Chicago 


The  40-hour-week  is  a myth  as  far  as 
Medical  Assistants  are  concerned.  They, 
like  their  employers,  are  willing  to  spend 
many  more  hours  in  self-improvement  and 
service  to  the  public. 

Since  our  goals  include  efficient  service 
to  both  the  profession  and  the  public,  self 
imjuovement  has  a major  share  in  our  lives. 
The  Illinois  Medical  Assistants  Association 
contributes  to  this  educational  process  by 
providing  seminars  throughout  the  year  de- 
signed to  broaden  our  knowledge  not  only 
in  the  field  of  medicine  but  in  medico-legal 
aspects,  pid)lic  relations  as  well  as  office 
management. 

The  Medical  Assistant  has  an  opportun- 
ity to  exchange  ideas  and  experiences  with 


others  working  in  her  field  and  thereby  en- 
larges her  knowledge  which  is  reflected  in 
her  work.  She  will  receive  publications  de- 
signed to  increase  her  capability  in  your 
office  and  practice.  So  the  40-hour-week  for 
Medical  Assistants  is  many  years  away.  She 
prefers  to  continue  her  education  through 
on-the-job  training,  educational  lecturers 
anti  idea  exchanges  with  other  Medical  As- 
sistants, which  results  in  a sense  of  personal 
accomplishment  as  well  as  better  perform- 
ance and  management  in  your  office. 

For  more  information  please  write  Mrs. 
Norma  Domanic,  150  Ash  Street,  New  Len- 
nox, Illinois  60451  or  Mrs.  Vivian  Kraft, 
RR  #2  Normal,  Illinois  61761. 


The  Next  Industrial  Revolution 

In  the  next  industrial  revolution,  there  must  be  a loop  back  from  the 
user  to  the  factory,  which  industry  must  close.  If  American  industrial  genius 
can  mass-assemble  and  mass-distribute,  why  cannot  the  same  genius  mass- 
collect,  mass-disassemble,  and  massively  reuse  the  materials?  If  American 
industry  should  take  upon  itself  the  task  of  closing  this  loop,  then  its  original 
design  of  the  articles  would  include  features  facilitating  their  return  and 
remaking.  If,  on  the  other  hand,  we  continue  to  have  the  private  sector 
make  things  and  the  public  sector  dispose  of  them,  designs  for  reuse  will 
not  easily  come  about.  (Athelstan  Spilhaus,  "The  Next  Industrial  Revolution," 
Science  167:3926  [Mar.  27]  1970,  page  1673.) 


160 


Illinois  Medical  Journal 


A service  of  the  Public  Relations  and  Economics  Division 


By  Joseph  J.  Lotharius 


An  Inconsistency  ^ Medicare  regulation  program  calls  for  patients  in  ex- 

In  Medicare  Law?  tended  care  facilities  (ECF')  to  be  seen  at  least  once  every  30 

days  by  their  physicians.  This  is  recjuircd  if  the  IGF  wishes 
to  retain  its  Medicare  eligibility  status.  However,  strictly 
speaking,  if  the  physician  reports  his  monthly  visit  on  the 
ECF  patient  as  not  being  “medically  necessary,”  he  will  not 
be  re-imbursed  by  the  Medicare  carrier. 

According  to  Medicare  regulations  for  re-imbursement, 
no  automatic  or  administrative  visits  are  allowed.  So,  to 
get  paid,  the  Ml)  might  be  required  to  “falsely  claim,  his 
visit  is  medically  necessary.”  There  seems  to  be  some  in- 
congruity in  the  Medicare  law  on  this  point.  The  regional 
office  of  the  Bureau  of  Health  Insurance  has  asked  the 
.Social  Security  Administration  office  in  Baltimore  to  make 
an  official  judgment  on  this  question. 


County  Societies 
Establish  Peer  Review 


More  than  one  third  of  the  state’s  92  county  medical 
societies  have  established  peer  review  committees  and  re- 
ported the  names  of  committee  members  to  ISMS.  Thus 
far,  39  county  societies  have  responded  on  an  ISMS  cpies- 
tionnaire  recpiesting  this  information.  (Thirty-seven  of 
these  have  appointed  a committee.)  Of  the  state’s  11 
trustee  districts,  the  Ninth  District,  comprised  of  14  coun- 
ties, leads  with  eight  responses.  District  Seven,  comprised 
of  1 1 counties,  is  next  with  six  replies;  the  Eighth  District, 
11  counties,  is  third  with  five  replies,  followed  by  the  fourth 
District,  12  counties,  with  four  responses. 

ISMS  Trustees  have  been  asked  to  contact  those  counties 
in  each  of  their  districts  which  have  not  yet  established 
peer  review  mechanisms  or  requested  that  such  peer  review 
be  done  by  the  District  Peer  Review  committee. 


Speed-Up  Promised  A speed-up  in  processing  previously  rejected  Medicaid 

For  Medicaid  Bills  bills  has  been  promised  in  the  near  future  by  the  Illinois 

Department  of  Public  Aid  (IDPA).  Department  officials 
said  all  bills,  rejected  for  any  reason  whatsoever,  would  be 
returned  to  the  individual  physician  immediately.  Form- 
erly, rejected  bills  had  been  held  for  a time  to  determine 
eligibility  and  the  appropriate  county  department  notified 
in  an  attempt  to  correct  the  bill  and  process  it  for  pay- 
ment. This  resulted  in  delays.  The  new  system  will  expe- 
dite bill  processing  and  will  promptly  inform  the  physi- 


for  August,  1970 


16! 


IDPA  Agreement 
Form  Cancelled 


cian  o[  the  reasons  why  his  Ijill  was  rejected.  In  the  long 
run,  IDPA  officials  think  the  new  method  will  also  speed 
lip  bill  payment. 

ISMS  members  soon  will  no  longer  be  recjuired  to  sign  a 
separate  IDPA  agreement  form  when  treating  public  aid  pa- 
tients. According  to  IDPA,  the  Department  of  Health  Edu- 
cation and  Welfare  (HEW)  has  given  its  approval  to  a 
revised  version  of  the  agreement  which  will  be  included 
on  every  IDPA  billing  form  and  signed  by  the  physician. 
IDPA  officials  said  the  new  billina:  forms  should  be  in  use 
sometime  this  fall. 


TAM  ...  a new  mannequin  for  museum 


TAM,  a new  transparent  anatomical 
mannc(|uin  designeil  specilically  loi  educa- 
tional museum  display  can  be  seen  and 
heard  in  the  center  of  the  Medical  bal- 
cony of  Chicago’s  Museum  of  Science  and 
Industry. 

A grant  to  the  Museum,  presentctl  joint- 
ly by  the  Illinois  Slate  Medical  Society,  the 
Chicago  Medical  Society  and  the  American 
Medical  Association,  made  the  exhiltit  pos- 
sible. 


Created  by  Richard  Rush  Studio  of  Chi- 
cago, T.VM  is  a hdl-sizcd,  three-dimensional 
model  showing  the  normal  anatomy  and 
describing  the  bodily  lutictions  of  the  hum- 
ati  female.  Unlike  her  predecessors  in  the 
medical  education  fteld,  TAM  is  cast  of  crys- 
tal clear  eperxy  with  a translucent  outer 
“skin,”  and  ititerior  sitrfaccs  hatid-painled 
in  translucent  color. 

All  of  her  organs  are  visible,  her  bones 
and  muscles  and  nerves  apparent,  but  ob- 
scuring nothing  ol  medical  importance. 
I'he  cenlnd  interior  lighted  section  has 
been  constructed  .so  that  each  organ  is  made 
visible  when  illumimited  during  the  pro- 
gressive accompanying  narration,  even 
though  it  may  be  behind  a layer  of  muscle 
or  some  other  element. 

The  three  scripts  have  been  written  in 
an  inlormal  and  contemporary  manner,  di- 
rected to  physicians  as  well  as  children. 
The  scripts  are  electrically  impulsed  to  ac- 
tuate the  lightitig  system  which  illuminates 
the  various  organs  of  TAM’s  body  as  the 
narration  explains  them. 

TAM  replaces  the  recently  retired  Camp 
Eransparetit  Woman,  long  one  of  the  Mu- 
seum’s most  popular  attractions.  The  man- 
netputi  can  be  seen  by  the  public  during 
the  Museum’s  regular  visiting  hours. 


Let's  Improve  Quality  of  Spirit 

"Our  purpose  to  improve  the  quality  of  man’s  life  must  encompass  more  than 
the  physical,  outward  and  tangible  aspects  of  life.  The  intangibles  of  spirit  and 
attitude  are  necessary  both  to  give  meaning  and  satisfaction  to  life  and  to  pro- 
vide the  drive  and  motivepower  for  finding  the  answers  to  the  flaws  that  we 
must  admit  exist  and  give  rise  to  our  problems." — F.  Ritter  Shumway,  new  presi- 
dent, Chamber  of  Commerce  of  the  United  States. 


162 


Illinois  Medical  Journal 


Men,  Money,  and  Medicine.  By  Eli  Ginz- 
bcTg,  Cokmibia  University  Press,  New 
York,  $8.50. 

This  book  presents  an  in-depth  commen- 
tary on  the  changing  strnctnre  of  health 
services  in  the  ETnited  States  with  major 
emphasis  on  tlie  rapid  changes  that  follow- 
ed the  intiodnction  of  Medicare  in  1965.  It 
clearly  conveys  the  ways  in  which  American 
Medicine  is  rooted  in  the  large  fabric  of 
onr  national  life  and  indicates  the  changes 
that  must  be  made  in  onr  values  and  insti- 
tutions before  the  health  industry  can  be 
significantly  restructured. 

Four  sections  make  up  this  systematic  ap- 
praisal of  the  political  economy  of  health. 
In  Part  One,  two  themes  predominate: 
What  are  reasonable  expectations  of  a sys- 
tem of  medical  care  for  an  affluent  country 
which  still  is  confronted  by  many  unmet 
needs?  And  what  have  been  some  of  the 
important  financial  and  manpower  trans- 
formations of  the  system  as  the  nation  has 
attempted  to  improve  both  the  provision 
and  distribution  of  health  services? 

fn  Part  Two,  the  focus  is  on  the  critical 
role  of  the  physician,  who  stands  at  the 
apex  of  the  system  and  whose  cooperation 


is  required  to  accomplish  significant  chang- 
es. Particidar  attention  is  directed  to  the 
fact  that  physicians,  as  all  Americans,  are 
free  to  determine  where  and  how  they  work, 
and  to  the  implication  of  this  freedom  of 
choice  for  inducing  changes  in  the  on-going 
system  of  medical  care. 

Part  Three  is  concerned  with  the  ever 
larger  role  jtlayed  by  allied  health  man- 
power. Particidar  note  is  taken  of  the  po- 
tentialities and  limitations  of  the  leadership 
of  specific  occtipational  groups  in  ration- 
alizing their  training  systems  and  altering 
employment  practices  so  that  their  members 
can  work  more  effectively  and  receive  higher 
compensation. 

Part  Four  is  concerned  with  illuminating 
the  problems  of  persons  sidfering  from 
chronic  conditions  or  mental  disability,  and 
the  extent  to  which  their  medical  needs 
are  intwined  with  the  socioeconomic  struc- 
ttnes  in  which  they  live  and  work. 

In  conclusion,  the  authors  point  up  the 
lessons  that  can  be  extracted  from  the  last 
twenty-five  years  of  the  nation’s  efforts  to 
improve  its  system  of  medical  care  and  re- 
late these  lessons  to  the  challenge  that  lies 
ahead. 


Legislatively  speaking 


By  the  ISMS  Legislation 
8c  Public  Affairs  Division 
Senate  Bill  1425,  backed  by  ISMS,  which 
exempts  medical  student  loans  from  the 
state’s  usury  law,  was  signed  by  the  Gov- 
ernor on  June  29,  1970. 

The  bill,  which  was  sponsored  by  Sena- 
tors Groen  (R-Pekin)  and  Dixon  (D-Belle- 
ville),  will  hopefully  be  of  some  aid  to  the 
doctor  shortage  in  Illinois. 

Senate  Bill  1425  will  now  exempt  loans 
to  medical  students  above  the  state’s  usury 
law  of  8%.  Continental  Illinois  Bank  and 


Trust  Company  provides  about  75%  of  the 
loans  now  being  made  to  medical  students. 
The  AMA  has  eliminated  the  risk  factor 
by  guaranteeing  repayment  of  all  defaulted 
loans. 

Loans  may  now  be  made  with  the  in- 
terest rates  to  exceed  the  state’s  usury  law, 
a 1%  payback  over  “prime”  during  the 
training  period  and  2%  over  “prime”  dur- 
ing the  repayment  period. 

An  amendment  was  attached  in  the 
House  to  eliminate  this  exemption  in  Jan- 
uary, 1972. 


for  August,  1970 


163 


Progressivism  at  the  AMA 


A presidential  oath 

Walter  C.  Bornenieier,  M.D.,  Chicago,  was 
sworn  in  as  125th  president  of  the  AMA  on 
Wednesday  at  the  Presidential  Inauguration 
Ceremony  by  Burtis  E.  Montgomery,  M.D., 
chairman  of  the  Board  of  Trustees. 


Walter  C.  Bornenieier,  M.D.,  1 25th  president  of  the  AMA, 
in  his  inangiiral  address  touched  upon  the  following  points: 

• alteration  of  approaches  in  training  physicians  to  bring 
about  an  early  solution  to  the  shortage  of  physicians 

• a five-point  program  to  improve  patient  care 

• shortening  of  the  medical  curriculum 

• modernizing  and  shortening  residency  programs 

• involving  students  in  patient  care  earlier  in  their  studies 

• assimilating  many  full-time  medical  teachers  into  pa- 
tient care  and  reducing  the  number  of  researchers  and 
research  institutions 


AMA  libertdizes  abortion  stand.  . 

Abandoned  was  the  AMA’s  traditional 
opposition  to  abortion  except  for  specific 
medical  reasons.  A new  policy  calling  abor- 
tion a “medical  procedure’’  to  be  per- 
formed by  a licensed  physician  in  an  ac- 
credited hospital  following  consultation 
with  two  other  physicians  chosen  for  their 
“professional  competence”  was  adopted. 

“Determinative”  factors  in  considering 
abortion  should  be  “sound  clinical  judg- 
ment . . . together  with  informed  patient 
consent,”  according  to  the  new  policy. 


$40  dues  increase  set  for  1 971  . . 

A |40  dues  increase  was  approved  by  the 
House  of  Delegates,  raising  the  dues  to 
$110  annually,  effective  Jan.  1,  1971.  The 
AMA  bylaws  were  also  changed  to  author- 
ize the  fixing  of  annual  dues  by  the  House 
rather  than  the  Board  of  Trustees. 

Liability  program  approved  . . . 

A professional  liability  insurance  pro- 
gram for  members  of  the  AMA  was  ap- 
proved by  the  House  of  Delegates.  The 
program  is  intended  to  provide  long-term 


164 


Illinois  Medical  Journal 


protection  to  members  of  the  AMA  in 
those  states  in  which  the  state  medical  asso- 
ciations elect  to  accept  the  provisions  of 
the  programs  and  agree  to  become  joint 
sponsors. 

AMA  planning  committee 
established  . , . 

The  House  of  Delegates  estaldished  a 
Committee  on  Long  Range  Planning  and 
Development  and  took  action  on  20  other 
recommendations  contained  within  the 
H inder  Report,  calling  for  some  controver- 
sial changes  in  health  care  delivery,  ranging 
from  a definition  of  health— “Health  is  a 
state  of  physical  and  mental  well-being” 
—to  a more  controversial  recommendation 
calling  for  the  AMA  to  sjjonsor  and  pro- 
mote the  formation  of,  and  participate  in, 
a National  Academy  of  the  Health  Pro- 


fessions for  Research  and  Policy. 

House  acts  on  special 
committee^ s recommendations  . , 

In  other  action,  the  House  adopted  the 
recommendation  of  its  sj^ecial  reference 
committee  which  heard  the  views  of  repre- 
sentatives of  consumer  and  other  groups. 

It  was  agreed  that  the  AMA’s  Board  of 
Trustees  shoidd  consider  creating  a multi- 
ethnic advisory  committee  on  health  care 
problems  of  minority  groups;  also  that  the 
House  should  consider  establishing  a refer- 
ence committee  at  each  Annual  and  Clini- 
cal Convention  to  hear  the  views  of  con- 
sumer and  other  public  groups  concerned 
with  health  care. 

The  House  reaffirmed  its  positions  that 
it  is  the  basic  right  of  every  citizen  to  have 
available  to  him  adeejuate  health  care. 


Sheen  Atvard  recipient 

Charles  B.  Huggins,  M.D.,  Nohel  Laureate 
and  University  of  Chicago  Pritzker  School  of 
Medicine  physician-researcher,  was  the  reciiiient 
of  the  $10,000  Sheen  Award  for  outstanding 
contrihulions  to  ineflicine.  Howard  F.  Hane- 
inan,  (left)  senior  vice-president  of  the  Guar- 
antee Bank  and  Trust  Co.  of  Atlantic  City, 
N.J.  presented  the  check  and  Walter  C.  Borne- 
ineier,  AMA  president,  gave  Dr.  Huggins  a coni- 
ineinoralive  i»laque. 


House  acts  on  Illinois  resolutions  . . . 


The  following  action  was  taken  by  the 
AMA  House  ol  Delegates  upon  the  resolu- 
tions submitted  by  Illinois: 

72 — liulividual  Piiltlic  Relations 

• adopted  an  amended  resolution  urging 
each  member  of  the  House  of  Delegates  to 
personally  present  to  the  local  news  media 
the  story  of  progressive  medicine  and  accu- 
rate figures  contrasting  costs  of  various 
types  of  insurance  programs,  hospital  costs 
in  private  and  government  hospitals,  and 
the  results  of  utilization,  peer  review  and 
other  such  committees  in  light  of  the  criti- 
cal news  coverage  which  implies  that  only 
a government  sponsored  national  insurance 
program  can  solve  the  nation’s  health  prob- 
lems. 


66 —  Protection  of  the  Public  from  Vntvarranted 
Medical  Statements 

• adopted  an  amended  resolution  call- 
ing for  the  AMA  House  of  Delegates  to  re- 
affirm the  right  of  individuals  to  seek  re- 
dress for  injuries  incurred  from  unwarrant- 
ed medical  statements  and  that  the  AMA 
through  its  public  relations  program  inform 
the  public  of  this  policy. 

67 —  Residency  Training  Programs 

• rejected  a resolution  requesting  the 
House  of  Delegates  of  the  AMA  to  con- 
demn the  actions  of  specialty  boards  which 
have  lengthened  their  training  require- 
ments, thereby  discouraging  more  physi- 
cians from  entering  already  critical  special- 
ties such  as  pediatrics  and  anesthesiology. 


for  August,  1970 


165 


Presidents  all! 


upon  receiving  information  that  retjuire- 
ments  have  not  been  increased  from  repre- 
sentatives of  the  specialties  in  (juestion. 


(>H — Liaison  with  Hospital  Hoards 

• adopted  a sul)stitute  resolution  calling 
lor  the  creation  of  an  elicctive  liaison  be- 
tween physicians  on  hospital  stalls  ami  the 
individual  members  of  hospital  hoards  ol 
directors  by  eticouraging  hospital  medical 
stalls  tf)  piti  chasc  individual  stdtsci  iptions 
to  the  American  Medical  News  or  other  ap- 
piopriate  publications  lor  members  of  the 
hospital  hoard  of  directors. 

H8 — H ospital  Reini bursem en t 

• referied  to  the  lioard  of  Trtistees  for 
disposition  a resolution  retpiesting  the 
y\MA  n onse  of  Delegates  to  endorse  the 
procednre  calling  for  jjrospective  rate  ne- 
gotiation as  the  method  of  hospital  reim- 
bursement and  urge  the  Blue  Cross  plans 
and  government  agencies  to  adopt  this 
method  as  the  basis  for  hospital  negotia- 
tion and  the  determination  of  hospital 
reimbursement. 

69 — Paffination  Policy  of  the  JAMA 

• referred  to  the  Board  of  Trustees  a 
resolution  that  JAMA  discontinue  its  cur- 
rent policy  of  pagination,  wherelry  adver- 


Three of  Ilinois  medical  presidents  gathered 
together  in  the  post-inauguration  reception  line. 
(Left)  J.  Ernest  Breed,  M.D.,  president  of  the 
ISMS,  Walter  C.  Bornemeier,  M.D.,  president 
of  the  AMA,  and  Fred  A.  Tworoger,  M.D., 
CMS  president. 


tising  pages  are  placed  in  the  scientific  text 
section,  and  return  to  the  former  practice 
of  numbering  editorial  and  scientific  pages 
independently  of  the  advertising  pages,  for 
binding  purposes. 

70 —  AM  A/ AMP  AC  Workshop-Washinfitoti  D.C. 

• referred  to  the  Board  of  Trustees  a 
resolution  proposing  that  the  Division  of 
Pidilic  Alfairs  sponsor  an  annual  public 
aifairs  conference  in  Washington  D.C.,  with 
a program  designed  to  attract  a large  num- 
lier  of  medical  society  members  from  each 
state  and  scheduled  for  a midweek  time 
when  the  maximum  contact  can  take  place 
between  physicians  and  their  elected  repre- 
sentatives. 

71 —  AMA  Physician's  Public  Affairs  Council 

• rejected  a resolution  calling  for  the  es- 
tablishment of  a Public  Ahairs  Council  or 
Committee  to  assist  in  planning  and  pro- 
gramming the  public  alfairs  progiam  which 
is  implemented  by  the  Division  of  Public 
Alfairs. 

6o — Promotion  of  the  Private  Practice  of 
Medicine 

• adopted  a resolution  that  the  AMA 
expand  its  efforts  toward  continuing  the 
promotion  of  private  practice  of  medicine. 


A Younger  Population 

If  you  sense  that  there  seems  to  be  more  young  people  around  today, 
you're  right.  In  the  past  decade,  the  population  14  to  24  years  old  in- 
creased almost  12  million,  to  39  million,  and  the  proportion  of  total  U.S. 
population  rose  from  15  per  cent  to  19  per  cent. 


166 


Illinois  Medical  Journal 


Film  Reviews 


"SAF-T-COIL-lnsertion  Techniques  and  Ef- 
fectiveness," is  the  title  of  a film  v/hich 
presents  a detailed  demonstration  of  an 
improved  insertion  technique  which  ap- 
pears to  have  contributed  to  the  unsur- 
passed success  rates  achieved  with  this  in- 
trauterine device. 

The  data  presented  in  the  film,  summa- 
rize three  recent  studies  of  a combined  to- 
tal of  3,640  patients  in  which  pregnancy 
prevention  rates  were  as  high  as  99.7%, 
with  removals  for  serious  complications  or 
infection  amounting  to  only  0.2%  in  one 
study. 

The  8mm,  color  and  sound  film  is  avail- 
able on  free  loan  to  physicians,  family 
planning  groups,  and  others  involved  in 
family  planning.  Contact:  Julius  Schmid, 
Inc.,  423  West  55th  Street,  New  York,  N.Y. 
10019. 

* * * 

"Human  Blood  Cell  Morphology"  depicts 
normal  cellular  elements  and  morphologi- 
al  alterations  in  red  cells,  white  cells  and 
platelets.  A descriptive  key  emphasizes 
changes  in  size,  shape  and  color  of  red 
blood  cells  in  acquired  and  congenital  ane- 
mias; and  white  cell  changes  which  occur 
in  infectious,  metabolic,  and  neoplastic  dis- 
eases. 

The  108  frame,  35mm  color  photomicro- 
graphic transparencies  would  be  of  interest 
to  personnel  concerned  with  clinical  hema- 
tology laboratory  procedures. 

Contact  for  free  short-term  loan:  Nat'onal 
Medical  Audiovisual  Center  (Annex),  Sta- 
tion K,  Atlanta,  Georgia  30324. 

* * * 

"Controversial  Aspects  of  Rheumatoid 
Arthritis"  covers  the  diagnostic  criteria  of 
rheumatoid  arthritis,  its  differentiation  from 
other  syndromes,  the  various  therapeutic 
regimens  advocated,  and  the  prognostic 
factors  affecting  such  patients.  Contact  for 
free  short-term  loan:  National  Medical  Au- 
diovisual Center  (Annex),  Station  K,  At- 
lanta, Georgia  30324. 

* * # 

"Oral  Cancer:  Detection  and  Diagnosis" 
is  geared  toward  increasing  the  ability  of 
dentists,  physicians  and  dental  hygienists 
to  detect  and  diagnose  oral  cancer  in  its 
earliest  stages.  Available  on  free  short- 
term loan  by  contacting:  National  Medical 
Audiovisual  Center  (Annex),  Station  K,  At- 
lanta, Georgia  30324. 


"Bladder  Outlet  Obstruction  in  Children 
—Diagnosis  and  Management"  is  a 16mm, 
color,  sound  film  which  discusses  types  of 
bladder  outlet  obstruction,  symptoms  and 
diagnostic  techniques.  Non-surgical  anti- 
reflux treatment  and  surgical  techniques  for 
bladder  neck  revision  and  ureteral  reim- 
plantation are  demonstrated  in  the  film. 

Contact:  National  Medical  Audiovisual 
Center  (Annex),  Station  K,  Atlanta,  Georgia 
30324. 

★ ★ * 

"Popliteal  Artery  Entrapment  Syndrome" 
is  a 16mm,  color,  sound  film  which  shows 
symptoms  and  surgical  treatment  of  three 
cases  of  popliteal  artery  entrapment  syn- 
drome resulting  from  congenital  anomaly. 

Contact:  National  Medical  Audiovisual 
Center  (Annex),  Station  K,  Atlanta,  Georgia 
30324. 

* * * 

"Control  of  Blood  Loss  in  Extensive  Auto- 
grafting" demonstrates  the  hemostatic  tech- 
nique used  successfully  by  the  U.S.  Army 
Research  Unit  to  control  blood  loss  in  ex- 
tensive autografting. 

The  16mm,  color,  sound  film  can  be  se- 
cured on  free  short-term  loan  by  contact- 
ing: National  Medical  Audiovisual  Center 
(Annex),  Station  K,  Atlanta,  Georgia  30324. 

★ * ★ 

"Tricuspid  Valve  Replacement  Following 
Blunt  Trauma"  demonstrates  surgical  re- 
placement of  tricuspid  valve,  and  focuses 
on  the  diagnostic  evaluation  of  the  trauma 
and  surgical  insertion  of  the  prosthetic 
valve. 


Family  Practice  exam  slated 

The  American  Board  of  Family  Practice 
announces  that  it  will  give  its  second  ex- 
amination for  certification  in  various  cen- 
ters throughout  the  United  States.  The  ex- 
amination will  be  over  a two-day  period 
on  February  27-28,  1971. 

Information  regarding  the  examination 
and  eligibility  can  be  obtained  by  writing: 
Nicholas  J.  Pisacano,  M.D.,  secretary-treas- 
urer, American  Board  of  Family  Practice, 
Inc.,  University  of  Kentucky  Medical  Center, 
Annex  #2,  Room  229,  Lexington,  Kentucky 
40506. 

The  deadline  for  receiving  completed  ap- 
plications is  November  1,  1970. 


for  August,  1970 


169 


CMS  calls  for  cooperativ 

Educating 


Dr.  A.  Nichols  Taylor,  president  of 
Chicago  Medical  School /University  of 
Health  Sciences  joined  the  institution  in 
1967.  He  was  formerly  director  of  the 
AMA’s  department  of  allied  medical  pro- 
fessions and  services,  and  associate  sec- 
retary of  the  Council  on  Medical  Educa- 
tion. 


By  June  Blythe/Chicago 


Over  the  past  12  years  the  cost  ol  health  tare  has 
risen  over  57%,  almost  twice  the  increase  ol  other 
cost-of-lic  itig  factors.  The  American  Medical  Associa- 
tion estimates  that  the  nation  is  short  50,000  doctors. 
The  Illinois  State  Medical  Society  says  there  are  only 
six  doctors  in  practice  for  every  ten  needed  in  the 
state.  In  six  out  of  seven  health  professions,  including 
nurses,  medical  and  dental  technicians,  pharmacists, 
and  dieticians,  Illinois  cities  fall  well  below  the  na- 
tional urban  average  in  ratio  of  professionals  to 
population. 

Shortages  and  high  costs  restrict  the  accessibility  of 
health  care  lor  nutch  of  the  pop. dace,  but  inner-city 
neighborhoods  bear  the  most  tragic  impact.  Such 
areas  have  only  half  as  many  physicians  in  private 
practice  (0.62  per  1.000  population)  as  more  affluent 
areas  (1.26  per  1,000).  according  to  a study  for  the 
Chicago  Board  of  Health  by  Drs.  Mark  H.  Lepper 
and  Joyce  C.  Lashoff.  Neighborhoods  such  as  Lawn- 
dale and  Englewood  suffer  an  infant  death  rate  from 
such  treatable  illnesses  as  influenza  and  pneumonia 
that  runs  four  to  five  times  the  rate  in  areas  such 
as  Chicago  Lawn  and  Rogers  Park. 

Crisis  in  Health  Care 

“There  is  a crisis  in  American  health  care,”  asserted 
the  National  Advisory  Commission  on  Health  Man- 
power in  a report  to  the  President.  It  went  on  to 
issue  this  warning:  “Unless  action  is  taken  soon, 
health  problems— like  the  problems  of  our  neglected 
urban  centers— may  no  longer  be  controlled.” 

The  Commission  has  called  for  “a  creative  part- 
nership of  pidtlic  and  private  enterprises”  which 


“might  even  become  a useful  model  for  progress  in 
other  fields.” 

Hope  for  just  such  a model  lies  in  the  innovative 
plan  of  the  Chicago  Medical  School.  Since  its  found- 
ing in  1912,  the  school  has  been  solely  committed 
to  training  physicians,  but  recognizing  that  physicians 
alone  can  no  longer  serve  the  health  care  needs  of 
the  public,  the  CMS  board  of  trustees  announced  in 
1967,  the  formation  of  a University  of  Health  Sci- 
ences. It  is  the  first  school  in  the  nation  to  develop 
an  educational  program  around  the  total  health  team 
concept. 

In  addition  to  maintaining  the  title  and  identity 
ol  the  Chicago  Medical  School,  the  University  ol 
Health  Sciences  encompasses  a developing  School 
of  Related  Health  Sciences,  and  a School  of  Gradu- 
ate and  Post  Doctoral  Studies,  already  underway. 

Remove  Obstacles 

The  goal  of  the  university  is  to  remove  the  dead- 
end obstacles  to  advancement  that  plagtie  most  of 
today’s  three  million  health  workers,  w'hile  simultan- 
eously doubling  the  school’s  production  of  physicians. 

Says  Dr.  LeRoy  P.  Levitt,  dean  of  the  Chicago 
Medical  School: 

“There  will  be  new  educational,  employment,  and 
professional  opportunities  for  inner  city  residents, 
who  in  turn  will  enhance  the  cjuality  and  quantity 
of  health  care  available  in  their  communities,” 

Construction  Grant 

Steps  to  forge  the  public-private  partnership  al- 
ready are  underway,  CMS  recently  became  the  first 


170 


Illinois  Medical  Journal 


ffort 


he  total  health  team 


private  medical  institution  in  the  country  to  recei\e 
a direct  state  construction  grant,  when  Governor 
Richard  Ogilvie  signed  a hill  awarding  $6.1  million 
toward  a new  classroom  building  adjoining  the  pres- 
ent structure  at  2020  West  Ogden  Avenue.  CALS  soon 
will  apply  for  an  |8  million  Federal  grant  and  anti 
cipates  that  the  enlarged  facilities  will  double  its 
class  of  medical  graduates  from  some  80  to  160  an- 
nually within  six  years  after  the  funds  become  avail- 
able. Illinois  applicants  will  have  preference  for  the 
additional  openings  provided  by  the  expansion.  CMS 
will  continue  its  55-year  commitment  to  train  sul)- 
stantial  numbers  of  general  practitioners  as  well  as 
specialists. 

Private  industry,  foundations,  and  alumni  are  be- 
ing asked  to  step  up  their  contributions  to  support 


Itoth  the  expanded  physician  training  and  the  new 
School  ol  Related  Health  Sciences.  Herman  M.  Finch, 
Chicago  industrial  relations  counsellor  and  chairman 
of  the  school’s  board  of  trustees,  points  out,  “The 
sitpport  of  the  medical  professions  is  the  most  im- 
portant function  of  tlic  citizenry.  Without  a healthy 
nation,  there  is  no  use  talking  about  economic  or 
intellectual  developments.” 

I’he  trustees  have  aireach'  been  raising  a minimum 
of  $6,000  per  year  for  each  medical  student,  whose 
tuition  pays  only  about  one-fourth  of  the  $8,000  an- 
nual cost  of  educating  him. 

Bargain  Program 

But  in  dollars  as  well  as  time,  the  program  is  a 
bargain.  Today’s  cost  of  building  a new  medical 


CMS  faculty  provides  staff  for  the  Martin  Luther  King  Neighborhood  Health 
Center  and  its  medical  students  train  there.  Funded  by  the  Office  of  Economic 
Opportunity,  the  Center  gives  training  in  paramedical  work  to  members  of  the 
community. 

I 


for  August,  1970 


171 


sdiool  is  in  the  range  of  $80  million  to  $100  mil- 
lion, in  addition  to  the  time  required  to  recruit  a 
faculty  and  the  lag  before  graduates  can  actually 
enter  practice. 

Dr.  A.  Nichols  Taylor,  CMS  president,  points  out 
that  if  each  of  the  tiation’s  90  existing  schools  would 
add  only  ten  students,  it  would  be  the  equivalent  of 
opening  nine  new  medical  schools,  based  on  the  aver- 
age size  of  entering  classes.  Fitting  deeds  to  convic- 
tion, CMS  last  year  admitted  12  per  cent  more  medi- 
cal students.  Nationally,  there  are  more  than  two 
qualified  applicants  for  each  of  the  approximately 
8,800  places  in  each  year’s  entering  classes  of  medical 
schools. 

The  health  care  crisis,  however,  goes  beyond  nu- 
mercial  shortages.  “Unless  we  improve  the  system 
through  which  health  care  is  provided,’’  says  the 
National  Advisory  Commission,  “care  will  continue 
to  become  less  satisfactory,  even  though  there  are 
massive  increases  in  cost  and  in  numbers  of  health 
personnel.” 

Americans  Jolted 

Yet  Americatis  have  been  rudely  jolted  to  learn 
that  20  other  countries  now  exceed  the  United  States 
in  life  expectancy  for  males  and  that  18  have  lower 
infant  death  rates. 

Paradoxically,  a major  factor  complicating  the 
“delivery”  of  health  care  is  the  advancement  of 
knowledge  and  techniques.  Some  250  new  procedures 
or  modifications  of  old  ones,  and  30  new  pieces  of 
equipment  enter  medical  technology  each  year,  ac- 
cording to  a report  prepared  for  the  Illinois  Board 
of  Higher  Education  under  the  direction  of  Dr.  James 
A.  Campbell.  Today’s  physician  must  have  a small 


“Unless  we  improve  the  system  through 
which  health  care  is  provided,”  says  the  Na- 
tional Advisory  Commission  on  Health  Man- 
power, “care  will  continue  to  become  less  satis- 
factory, even  though  there  are  massive  increases 
in  cost  and  in  numbers  of  health  personnel.” 


army  of  paramedical  personnel  just  to  take  advan- 
tage of  this  proliferation  of  techniques. 

Meanwhile,  the  proportion  of  doctors  providing 
direct  care  to  patients  has  declined,  from  98.5  per 
cent  in  1930  to  64.9  per  cent  in  1966.  Almost  one 
doctor  in  ten  no  longer  treats  patients,  but  performs 
the  equally  essential  tasks  of  teaching,  research,  pre- 
ventive medicine,  etc.  And  of  those  who  do  treat  pa- 
tients, about  one-fourth  now  perform  this  service 
through  hospitals  or  other  institutions.  Especially 
scarce  are  general  practitioners,  the  family  doctors, 
with  less  than  2 per  cent  of  today’s  graduates  enter- 
ing general  practice. 

At  the  same  time,  hospital  care,  too,  must  accom- 
modate the  multiplying  technology.  Over  a 15-year 
period,  says  the  Campbell  report,  the  number  of 
laboratory  and  diagnostic  procedures  (such  as  X-ray) 
for  each  hospital  admission  have  more  than  doubled 
—one  important  cause  of  mounting  costs  and  person- 
nel shortages. 

Just  as  numbers  alone  do  not  explain  the  medical 
supply  shortage,  neither  does  sheer  population  growth 
clarify  the  swelling  demand.  Dr.  Taylor  points  out 
that  the  population  profile  is  changing,  with  the 
biggest  growth  coming  in  the  proportions  of  the 
young  and  the  old— the  two  ends  of  the  spectrum  re- 
quiring the  most  medical  care.  Further,  the  effective 
tlemand  has  been  boosted  by  third-party  payments, 
via  private  and  public  insurance  and  aid  programs— 
more  people  can  afford  more  care.  Finally,  the 
amount  of  public  information  about  health  care  has 
risen  to  the  point  where  medical  service  no  longer 
is  regarded  as  a privilege,  but  as  a right. 

(Continued  on  page  175} 


172 


Illinois  Medical  Journal 


Total  health  team 

(Continued  froni  page  172) 

One  Basic  Solution 

One  basic  solution,  says  Dr.  Taylor,  is  to  increase 
the  individual  physician’s  effectiveness.  If,  for  ex- 
ample, he  has  been  seeing  two  patients  an  hour,  he 
could  Ije  helped  with  the  right  kind  of  supportive 
personnel  to  see  three  patients  an  hour.  In  effect, 
the  number  of  physicians  would  rise  Ity  50  per  cent. 

Cooperative  Effort 

CMS  plans  call  for  a cooperative  effort  with  six 
hosjritals,  four  community  colleges  and  two  vocational 
schools  to  construct  a correlated  educational  and  job 
training  program  through  which  the  individual  can 
progress,  with  his  pace  dependent  only  on  his  ability 
and  potential.  A ward  aide,  for  example,  could  pro- 
ceed through  training  and  jobs  as  a licensed  practical 
nurse,  to  a degree  nurse,  and  then  a baccalaureate 
degree  at  CMS  without  at  any  step  having  to  repeat 
mundane  essentials  learned  at  an  earlier  level.  The 
professional  nurse  coidd  then,  if  desired,  apply  for 
medical  school,  or  for  graduate  work  in  one  of  the 
medical  sciences. 

Heading  up  the  program  as  dean  of  the  School  of 
Related  Health  Sciences  is  Dr.  Israel  Light,  who  left 
his  career  post  at  the  National  Institutes  of  Health 
to  take  on  this  new  challenge.  Dr.  Light  was  chief 
of  educational  program  development  for  the  allied 
health  field  in  the  Institute’s  Bureau  of  Health 
Manpower. 

Next  fall  the  School  likely  will  offer  a two-year 
degree  course  in  physical  therapy  (with  a two-year 
general  college  background  as  a prerequisite.)  This 
may  be  followed  by  similar  courses  in  occupational 
therapy  and  radiologic  technology.  Courses  in  phy- 
sical and  occupational  therapy  are  offered  at  only 
two  other  colleges  in  the  state,  and  no  bachelor’s 


degree  in  radiologic  technology  is  availalrle  despite 
the  acute  need  lor  managerial  and  .siqrervisory  per- 
sonnel in  this  field. 

Discussions  also  are  underway  for  CMS  to  assume 
teaching  responsibility  for  paramedical  courses  now 
offered  at  Mt.  Sinai  Hospital,  the  teaching  hospital 
for  CMS  medical  students. 

Dr.  Light  shares  with  Dr.  Taylor  a sense  of  com- 
mitment to  the  needs  of  the  communities  surround- 
ing CMS  and  the  West  Side  Medical  Center  where 
it  is  located. 

“We  live  in  a certificate-oriented  society,”  com- 
ments Dr.  Light,  “and  we  have  confused  ‘education’ 
with  ‘competence.’  We  want  to  try  to  bridge  the 
gap  between  academia  and  the  world  of  work,  to 
salvage  peo|)le  of  ability  who  have  never  had  the 
opjjortunity  to  get  that  certificate.” 

Enthusiastically  Endorsed 

Lhis  thesis  is  endorsed  enthusiastically  by  Dr.  Ker- 
mit  Mehlinger,  director  of  the  Martin  Luther  King, 
Jr.,  Neighborhood  Health  Center,  at  3312  West  Cren- 
shaw. CMS  faculty  provides  staff  for  the  Center,  and 
its  medical  students  serve  there  as  part  of  their  train- 
ing. Funded  by  the  Olfice  of  Economic  Opportunity, 
the  Center  also  gives  training  and  employment  in 
paramedical  occupations  to  members  of  the  com- 
munity. Land  and  the  building  were  provided  by 
Sears,  Roebuck  and  Company. 

An  even  closer  and  more  formal  relationship  be- 
tween the  Center  and  CATS,  with  exjiandcd  training 
opportunities  from  the  high  school  level  upward, 
is  expected  soon. 

A similar  relationship  is  antici|rated  when  Chicago 
constructs  a city  neighborhood  health  center  in  the 
area.  This  would  be  one  of  the  three  centers  for 
which  bonds  were  voted  in  1966,  now  slated  to  be 
built  under  the  Alodel  Cities  program. 

(Reprinted  from  Commerce,  February,  1970) 


Neighborhood  Health  Center 

The  health-center  movement  developed  in  many  places  throughout  the 
world.  Centers  became  a part  of  governmental  systems  of  health  care  in 
such  countries  as  Russia,  Yugoslavia  and  Chile.  The  English  plans  were 
never  realized  although  a flurry  of  centers  was  reported  after  World 
War  II  and  the  famous  Peckham  experiment. 

The  new  centers  are  now  being  sponsored  by  hospitals,  medical  schools, 
citizen  groups,  medical  societies  and,  less  often,  by  health  departments. 
Under  new  sponsorship,  these  centers  are  developing  at  the  same  time 
that  group  practice,  a kind  of  private  entrepreneurial  health  center,  re- 
ceives a stamp  of  professional  and  public  approval  and  when  another 
health-center  movement  in  mental  health,  quite  separated  from  medical 
practice,  has  also  developed.  (John  D.  Stoeckle,  M.D.,  and  Lucy  M.  Candib: 
"The  Neighborhood  Health  Center— Reform  Ideas  of  Yesterday  and  Today," 
New  Eng.  J.  Med.  280:25  [June  19]  1969.) 


for  August,  1970 


175 


Iodized  Salt  for  the  Prophylaxis  of  Endemic  Goiter 

It  is  necessary  again  to  review  the  problem  of  goiter  prophylaxis.  There 
is  ample  data  proving  that  endemic  goiter  can  be  prevented,  and  simple 
practical  methods  of  prevention  are  known.  The  present  need  is  to  place 
this  important  public  health  problem  under  the  proper  authority  so  that 
it  will  be  continued  generation  after  generation. 

The  prevention  of  endemic  goiter  in  man  on  a large  scale  was  begun 
in  1916.  This  research  was  started  through  the  public  schools  in  Akron, 
Ohio,  by  Marine  and  Kimball  and  was  described  in  detail  at  that  time. 
By  1920,  it  had  been  shown  most  convincingly  that  endemic  goiter  in 
adolescent  girls  could  be  prevented  by  keeping  the  thyroid  saturated  with 
iodine.  From  1920  to  1924,  many  cities  both  in  the  United  States  and 
abroad  were  carrying  out  parallel  programs  for  the  prevention  of  goiter. 

During  these  same  years  an  improved  method  of  determining  minute 
quantities  of  iodine  was  developed,  and  by  1924,  the  water  in  our  en- 
demic goiter  regions  had  been  analyzed. 

The  Michigan  State  Department  of  Health  and  the  Michigan  State  Medi- 
cal Society  made  the  first  organized  effort  to  prevent  goiter  by  the  use 
of  iodized  salt.  The  salt  producers  agreed  to  make  a table  salt  containing 
potassium  iodide  0.02%.  The  wholesale  grocers  agreed  to  handle,  as  far 
as  possible,  only  iodized  salt  for  table  use.  The  cost  of  this  iodine  was 
borne  equally  by  the  producers  and  by  the  wholesale  grocers,  so  that  the 
cost  to  the  consumer  was  the  same  as  for  ordinary  table  salt. 

Neither  the  manufacturer  nor  the  wholesale  grocer  was  to  advocate  the 
use  of  iodized  salt  or  to  advertise  it  in  any  way.  Promotion  was  left  en- 
tirely to  the  state  department  of  health  and  to  the  medical  profession.  Lec- 
tures, newspaper  articles,  radio  talks  and  placards  in  every  school  ex- 
plained briefly  the  thyroid  gland,  its  function  and  chemistry.  The  depend- 
ence of  normal  thyroid  function  on  iodine  was  stressed,  and  the  deficiency 
of  iodine  as  the  sole  cause  of  endemic  goiter  was  repeatedly  emphasized. 
This  campaign  resulted  in  the  use  of  iodized  salt  in  approximately  75% 
of  the  homes  in  Michigan  beginning  in  May,  1924. 

As  was  expected,  there  were  a few  papers  written  by  medical  men  ex- 
pressing anxiety  and  fear  lest  the  use  of  iodized  salt  produce  toxic  goiters. 
Because  of  these  few  articles,  which  made  some  startling  claims,  it  was 
necessary  in  1927,  and  1928  to  make  a resurvey  throughout  the  same 
counties  in  Michigan,  both  to  learn  the  efficiency  of  iodized  salt  and  to 
determine  any  harmful  effects  from  its  continued  use.  Stated  briefly,  the 
use  of  iodized  salt  was  a very  efficient  and  practical  method  of  goiter  pro- 
phylaxis and  found  to  be  entirely  safe.  Throughout  this  resurvey  not  a 
child  was  found  who  showed  the  slightest  ill  effect  from  the  use  of 
iodized  salt.  • . ir/j 

In  spite  of  the  many  surveys  in  this  country  and  abroad,  there  appears 
to  be  no  cumulative  knowledge  among  the  general  population  about  the 
cause  and  prevention  of  endemic  goiter.  Furthermore,  there  is  an  abund- 
ance of  data  on  the  efficiency  and  safety  of  iodized  salt  as  the  means  of 
prophylaxis;  yet  the  consumption  by  the  general  public  gradually  de- 
creases unless  repeated  campaigns  are  made  by  state  health  departments 
to  encourage  its  use.  (O.  P.  Kimball,  M.D.:  Iodized  Salt  for  the  Prophylaxis 
of  Endemic  Goiter.  J.A.M.A.  [Jan.]  1946.  130:80-81.) 


Why  the  Coins  Drop  Slowly  Away 

"Inflation  doesn't  rob  the  cash  register  in  a direct  and  honest  way. 
It  merely  eats  the  bottom  out  of  it  and  the  coins  slowly  drop  away."— 
Jenkin  Lloyd  Jones,  president,  Chamber  of  Commerce  of  the  United  States. 


176 


Illinois  Medical  Journal 


THE  VIEW  BOX 


(Continued  from  page  129) 

Diagnosis:  Mediastinal  pancreatic  pseudo- 
cyst 

The  occurrence  of  a mass  which  extends 
in  continuity  from  the  retroperitoneal  to 
the  posterior  mediastinal  space  with  an  an- 
terior displacement  of  the  esophagus  and 
stomach  should  suggest  the  entity  of  me- 
diastinal pseudocyst.  This  is  a rather  rare 
condition  with  seven  cases  reported  in  the 
American  literature. 

An  abdominal  exploration  disclosed  a 
huge  mass  adherent  to  the  posterior  wall 
of  the  stomach  which  extended  through  the 
esophageal  hiatus  and  displaced  the  esopha- 
gus anteriorly.  The  mass  arose  in  the  body 
of  the  pancreas  and  when  probed  yielded 
500cc  of  fluid  with  serum  amylase  of  2018 
units.  A cystogastrostomy  was  performed. 
On  the  patient’s  return  one  year  later,  the 
pancreatic  pseudocyst  was  recurrent  with- 
out the  mediastinal  extension. 


Reference 

C:,  J.  Revues  and  Leon  Love,  ‘'^[ediastinal  I’seiido 
cyst,”  Radiology  92:115-116,  January,  1969 


Surgical  Grand 
Rounds 

(Continued  from  page  12S) 
which  result  from  metastatic  disease  or 
other  space-occupying  lesions.  labelled 
Rose  Bengal  can  be  used  to  assess  liver 
function  by  measurement  of  the  rate  of 
disappearance  from  the  blood  stream.  In 
addition,  it  is  excreted  by  the  liver  so  that 
failure  of  the  isotope  to  appear  in  the  duo- 
denum suggests  obstruction  of  the  bile 
ducts. 

When  available,  these  tests  are  useful  and 
add  considerable  information,  particularly 
when  the  cau.se  of  jaundice  is  obscure  or 
uncertain. 


Dedicated  to  Progressive  Psychiatry 
and  Oriented  to  Short  Term 
Hospitalization  and  Treatment 


'MAN  IS  NOT  SOUL  OR  BODY,  BUT  THESE 
TWO  SUBSTANCES  INMOSTLY  UNITED" 


Psychological  and  Physiological  ther- 
apies for  the  neuroses,  psychoses  and 
psychosomatic  disorders,  with  special 
emphasis  on  INSULIN  DEEP  COMA 
THERAPY  for  the  schizophrenias  and 
the  newly  developed  INDOKLON 
THERAPY  for  the  depressions. 


References 

1.  Anse.  R.  G.,  and  Wagner.  H.  N.,  Jr.,  ‘‘Diag- 
no.stic  Value  of  Scintillation  Scanning  of  the 
Liver,”  Arch.  Int.  Med.,  116:95,  1965. 

2.  Drake,  C.  T.,  and  Beal,  J.  M.,  ‘Tercutaneotis 
Cholangiography,”  Arch.  Surg.  91:558,  1965. 


Illinois  has  127  commercial  airports  and 
500  private  landing  areas. 

*  *  * * 


FOR  ADOLESCENTS;  Quality  care  with 
specialized  programs  including  ac- 
credited schooling. 

Phone:  312-878-9700 
4840  NORTH  MARINE  DRIVE 
CHICAGO,  ILLINOIS  60640 

J.  Dennis  Freund,  M.D.,  Medical  Director 


for  August,  1970 


177 


Taste! 


Dicarbosil. 

ANTACID 

Your  ulcer  patients  and 
others  will  love  it.  Specify 
DICARBOSIL  144  S-144  tab- 
lets in  12  rolls. 

f lARCH  LABORATORIES 

T I 319  South  Fourth  Street.  St.  Louis,  Missouri  63102 


COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 

STARTING  DATES— 1970 

SPECIALTY  REVIEW  COURSE  IN  MEDICINE,  Part  I,  Sept. 
14  & 21 

SPECIALTY  REVIEW  COURSE  IN  THORACIC  SURGERY,  Sept.  21 
SPECIALTY  REVIEW  COURSE  IN  UROLOGY,  Three  Days,  Oct.  14 
SPECIALTY  REVIEW  COURSE  IN  OB/GYN,  October  19 
SPECIALTY  REVIEW  COURSE  IN  SURGERY,  Part  I,  October  19 
PROCTOSCOPY  & VARICOSE  VEINS,  One  Week,  September  14 
SURGERY  OF  THE  HAND,  Three  Days,  September  15 
SURGERY  OF  HEAD  AND  NECK,  One  Week,  September  21 
SURGERY  OF  STOMACH  & DUODENUM,  One  Week,  Sept.  28 
VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  Oct,  5 
ADVANCES  IN  GYNECOLOGY  & OBSTETRICS,  One  Week, 
Sept.  28 

PEDIATRIC  SURGERY,  One  Week,  September  28 
GENERAL  PRACTICE  REVIEW  COURSE,  One  Week,  Sept.  14 
BASIC  ELECTROCARDIOGRAPHY,  One  Week,  October  5 
BASIC  INTERNAL  MEDICINE,  One  Week,  October  12 
DERMATOLOGY,  One  Week,  October  5 
DIAGNOSTIC  RADIOLOGY,  One  Week,  September  21 
RADIOISOTOPES,  One  or  Two  Weeks.  Request  Dates 
INHALATION  & REGIONAL  ANESTHESIA.  Request  Dates 

Information  concerning  numerous  other 
continuation  courses  available  upon  request, 

TEACHING  FACULTY 

Attending  Staff  of 
Cook  County  Hospital 

Address: 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 


Meeting  Memos 

August  23-28 — Flying  Physicians  Asso- 
ciation 

Sixteenth  Annual  Meeting 

Bayshore  Inn,  Vancouver,  British  Columbia 

September  14-16 — American  Electroen- 
cephalographic  Society 

Continuation  Course 

“Current  Practice  of  Clinical  Electroencephalo- 
graphy” 

Washington,  D.C. 

September  14-18 — Mallinckrodt  Insti- 

tute of  Radiology 

Postgraduate  Course 

Bone  and  Joint  Roentgenology  for  Radiologists  and 
Orthopedic  Surgeons 

■Stouffer’s  Riverfront  Inn,  St.  Louis,  Missouri 

September  17-19 — University  of  Ken- 
tucky 

Postgraduate  Course 

"Pulmonary  Function  Tests  in  Management  of 
Chest  Disease” 

Ihiiversity  of  Kentucky  Medical  Center 

September  19-20 — American  Medical 
Association 

Third  National  Co}igress  on  Medical  Ethics 
.-Vmbassador  Hotel,  Chicago 

September  19-2.3 — University  of  Illinois 
Department  of  Otolaryngology 

Annual  Otolaryngologic  Assembly 
Condensed  postgraduate  basic  and  clinical  program 
Eye  and  Ear  Inlirmary  of  the  LTniversity  of  Illinois 
Ho.spital 

September  23 — The  Adolph  Gunderson 
Metlical  Foundation  and  The  Wiscon- 
sin Heart  Association 

Symposium 

Surgery  and  the  Coronary  Artery— An  Evaluation 
The  I\'isconsin  Stale  University  at  LaCrosse 

September  28 — Illinois  Registry  of  Ana- 
tomic Pathology 

Seminar 

Fourth  Monday  of  each  month,  7:00  p.m, 

Hektoen  Institute,  627  South  Wood  Street,  Chicago 


500  cases  of  appendicitis 

(Co)ilittited  from  page  149) 

7.  Ochsner,  A,,  and  Johnston,  J,  H.:  “Appendiceal 
Peritonitis,”  Surg.,  18:873,  1945. 

8.  Longino,  L.  A.,  Holder,  T.  M.,  and  Gross,  R. 
E.:  “Appendicitis  in  Childhood,”  Pediat.,  238, 
1958. 

9.  Strohl,  E.  Lee,  and  Dilfenhaugh,  W.  G.:  “The 
Historical  Background  of  the  Gridiron  or 
Muscle-Splitting  Incision  for  Appendectomy,” 
IM.J.,  136:3,  pp.  287-288,  352  (March)  1969. 

10.  Ross,  F.  P.,  Zarem,  H.  A.,  and  Morgan,  P.: 
“Appendicitis  in  a Community  Hospital,”  Arch. 
Surg.,  85:186,  1962. 


Illinois  is  the  center  of  the  nation's  popu 
lation. 

* * * 


178 


Illinois  Medical  Journal 


Illinois  Medical  Journal 

volume  138,  number  3 September,  1970 


Editor  

Managing  Editor  

Medical  Progress  Editor 

Editorial  Assistant  

Advertising  Manager  ... 
Executive  Administrator 


Theodore  R.  Van  Dellen,  M.D. 

Richard  A.  Ott 

Harvey  Kravitz,  M.D. 

Michaelyn  Sloan 

John  A.  Kinney 

Roger  N.  White 


CONTENTS 


ABSTRACTS  OF  BOARD  ACTIONS  207 

CLINICAL  ARTICLES 

Arteriogiaphy:  principles  and  techniques 
Paul  B.  Savory,  M.D 215 

Meteorologic  factors  in  the  fallout  of  pollens  and  molds 
Herman  A.  Heise,  M.D.,  and  Eugenia  R.  Heise,  M.T 224 


The  private  non-affiliated  metropolitan  community 
hospital:  Its  responsibility  as  related  to  post- 


graduate medical  education 

Lawrerice  G.  Khedroo,  M.D.,  D.D.S 234 

SURGICAL  GRAND  ROUNDS 

Neurogenic  ttimor  of  the  mediastinum  229 

SPECIAL  ARTICLES 

Statute  of  limitations  in  malpractice  lawstiits 
Frank  M.  Pfeifer,  Counsel,  ISMS  239 

Medical  Licensure:  Let’s  reciprocate 

George  H.  Burke,  M.D -240 

Medical  Licensure:  Let’s  not  reciprocate 

Licensure  Problems  in  Illinois 

Kenneth  II . Schnepp,  M.D.,  and  William  G.  McCarthy,  M.D 241 

Paul  R.  Ehrlich:  A biologist’s  remarks  on  the 
“population  explosion” 

Michaelyn  Sloan  246 

FEATURES 

Blue  Shield  Report  183 

Meeting  Memos  192 

The  President’s  Page  194 

Clinics  for  Crippled  Children  197 

The  View  Box  ...223 

New  Pharmaceutical  Specialties  226 

Public  Affairs  Library  245 

The  Doctor’s  Library  250 

Illinois  Medical  Assistants  Association  251 

Socio-Economic  News  255 

Editorials  257 

Physicians’  Placement  Service  ...273 

Obituaries  280 


(Cover  story  on  page  188) 


ILLINOIS  STATE 
MEDICAL  SOCIETY 

360  N.  Michigan  Ave.,  Chicago,  60601 
OFFICERS 

J.  Ernest  Breed,  President 

55  East  Washington  Street,  Chicago  60602 
L.  T.  Fruin,  President-Elect 
5 Citizen's  Square,  Normal,  61761 
George  C,  Shropshear,  1st  Vice-President 
1525  East  53rd  Street,  Chicago,  60615 
C.  J.  Jannings,  III,  2nd  Vice-President 
101  East  Center  Street,  Fairfield,  62837 
Jacob  E.  Reisch,  Secretary-Treasurer 

1129  South  2nd  Street,  Springfield  62704 
Paul  W.  Sunderland,  Speaker 

214  North  Sangamon  St.,  Gibson  City,  60936 
Andrew  J.  Brislen,  Vice-Speaker 

6060  South  Drexel  Blvd.,  Chicago  60637 
Willard  C.  Scrivner,  Chairman  of  the  Board 
4601  State  Street,  East  St.  Louis,  62205 


TRUSTEES 

Joseph  L.  Bordenave,  1st  District  (1971) 

1665  South  Street,  Geneva,  60134 
William  A.  McNichols,  Jr«,  2nd  District  (1971) 
101  West  First  Street,  Dixon,  61021 
Fredric  D.  Lake,  3rd  District  (1972) 
j 1041  Michigan  Avenue,  Evanston,  60202 
I James  B.  Hartney,  3rd  District  (1973) 

410  Lake  Street,  Oak  Park,  60302 
I Frank  J.  Jirka,  3rd  District  (1971) 
j 1507  Keystone  Ave.,  River  Forest,  60305 
: William  M.  Lees,  3rd  District  (1971) 

I 6518  N.  Nokomis,  Lincolnwood,  60646 
; Frederick  E.  Weiss,  3rd  District  (1973) 

15643  Lincoln  Avenue,  Harvey,  60426 
j Warren  W.  Young,  3rd  District  (1972) 

10816  Parnell  Avenue,  Chicago,  60628 
Fred  Z.  White,  4th  District  (1973) 

723  North  Second  St.,  Chillicothe,  61523 
A.  Edward  Livingston,  5th  District  (1973) 

219  North  Main,  Bloomington,  61701 
J.  Mather  Pfeiffenberger,  6 District  (1972) 

State  & Wall  Streets,  Alton,  62002 
Arthur  F.  Goodyear,  7th  District  (1973) 

142  East  Prairie  Avenue,  Decatur,  62523 
Eugene  P.  Johnson,  8th  District  (1973) 

22  West  Main  Street,  Casey,  62420 
Charles  K.  Wells,  9th  District  (1972) 

117  North  10th  Street,  Mt.  Vernon,  62864 
Willard  C.  Scrivner,  10th  District  (1972) 

4601  State  Street,  East  St.  Louis,  62205 
: Joseph  R.  O'Donnell,  11th  District  (1971) 

1 444  Park,  Glen  Ellyn,  60137 

• Edward  W.  Cannady,  Trustee-at-Large 
4601  State  Street,  East  St.  Louis,  62205 


Microfilm  copies  of  current  as  well  as  some  back 
issues  of  the  Illinois  Medical  Journal  may  be 
purchased  from  Xerox  University  Microfilms,  300 
N.  Zeeb  Road.  Ann  Arbor,  Mich.,  48106. 


Published  monthly  by  the  Illinois  State  Medical 
Society,  360  N.  Michigan  Ave.,  Chicago,  111.,  60601. 
Copyright  1970,  The  Illinois  State  Medical  Society. 

Subscription  $5.00  per  year,  in  advance,  postage 
; prepaid,  for  the  United  States,  Cuba,  Puerto  Rico, 
; Philippine  Islands  and  Mexico.  $7.50  per  year  for 
all  foreign  countries  included  in  the  Universal  Postal 
Union.  Canada  $5.50  U.S.  Single  current  copies 
available  at  75c. 

Second  class  postage  paid  at  Chicago,  111.  and  at 
i additional  mailing  offices.  When  moving  please  notify 


Journal  office  of  new  address  including  old  mailing 
label  with  notification,  if  possible.  POSTMASTER: 
Send  notice  on  form  No.  3579  to  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave.,  Chicago, 
111.  60601. 

Pharmaceutical  advertising  must  be  approved  by 
the  ISMS  Publications  Committee.  Other  advertising 
accepted  after  review  by  Publications  Committee  of 
Board  of  Trustees.  All  copy  or  plates  must  reach  the 
Journal  office  by  the  fifteenth  of  the  month  preceding 
publication.  Rates  furnished  upon  request. 


Original  articles  will  be  considered  for  publication 
with  the  understanding  that  they  arc  contributed  only 
to  the  Illinois  Medical  Journal.  The  IS^IS  denies 
responsibility  for  opinions  and  statements  expressed  by 
authors  or  in  excerpts,  other  than  editorial  or  allied 
views  or  statements  which  reflect  the  authoritative 
action  of  the  ISMS  or  of  reports  on  official  actions, 
policies  or  positions.  Views  expressed  by  authors  do 
not  necessarily  represent  those  of  the  Society;  any 
connection  with  official  policies  is  coincidental. 


for  September  1970 


187 


Give  the  Earth  a Chance! 

Become  involved  while  ihe  earth  still  has  a chance: 

1 . Save  water. 

Don't  leave  the  water  running  while  shaving  or 
brushing  your  teeth.  Make  sure  your  faucets  don't 
leak;  a few  drops  can  add  up  tc  several  hundred 
gallons  a year.  Use  ice  cubes  if  you  want  cold  water; 
don't  let  the  water  run. 

2.  Burning  rubbish  and  leaves  only  adds  to  air  pollution. 

3.  Bury  leaves,  grass,  organic  garbage,  etc.  and  use  it 
as  fertilizer  for  your  garden.  Organic  garbage 
buried  6 inches  deep  will  decompose  and  fertilize 
the  soil. 

4.  Avoid  buying  beverages  in  no-deposit,  no-return 
containers;  these  throw-aways  neither  burn  nor  waste 
away,  and  we're  running  out  of  places  to  bury  them. 

5.  Recycle  wastes:  paper,  aluminum,  rags,  etc. 

—Sell  old  cloth  to  rag  companies. 

— Refuse  to  buy  products  in  non-reusable  containers. 
— Use  all  paper  products  sparingly. 

—Use  popcorn  or  other  bio-degradable  substitutes  to 
cushion  mailed  items. 

6.  Use  less  electricity. 

The  more  you  use,  the  easier  it  is  for  power  com- 
panies to  justify  more  dams,  nuclear  reactors  and 
power  facilities.  Give  second  thoughts  to  using  that 
electric  can  opener,  electric  carving  knife  and  electric 
fry  pan. 

7.  Support  local,  state  and  federal  officials  fighting 
pollution;  become  familiar  with  pending  anti-pollu- 
tion bills  and  voice  your  opinions. 

8.  Avoid  using  internal  combustion  engines. 

Use  a hand  mower  instead  of  a power  mower;  a 
canoe  or  sailboat  is  healthier  than  a power  boat. 

9.  Encourage  natural  predators  like  birds  to  control 
insects  by  planting  trees  and  shrubs,  and  building 
bird  houses. 

Fertilizers  with  lead  arsenate  kill  birds,  pets  and 
children. 

10.  Don't  buy  furs  and  other  wild  animal  products.  The 
demand  for  such  luxuries  hastens  extinction  of  many 
species  of  mammals,  reptiles  and  birds. 


PoSIution  Control  Spending  Peaks 

Pollution  control  spending  rose  23%  in  1969,  to  a record  of  $256  mil- 
lion among  248  companies,  according  to  a survey  by  the  National  In- 
dustrial Conference  Board. 


ON  THE  COVER 

"Preserve"  is  the  theme  of  this  month's  Illinois  Medical  Journal— ourselves  and  our  environ- 
ment. With  the  word  "pollution"  running  rampant  through  everything  we  read,  see  and  hear, 
it  is  time  we  each  survey  our  own  actions  in  terms  of  contributors  to  the  pollution  problem. 

By  voting  "yes"  on  the  November  3,  anti-pollution  bond  issue,  you  can  bring  pollution  con- 
trol to  the  sewage  problem  now  confronting  Illinois  waters.  Taking  the  time  out  to  cast  your 
ballot  is  your  way  of  initiating  the  mass  clean-up  that  lies  before  us. 

Cover  art  by  Mike  Ahearn. 


188 


Illinois  Medical  Journal 


'M 


Medical  Assistant 
Workshops  Underway 


The  Community— 
We  Are  Involved 


In  September,  Illinois  Blue  Shield  will  begin  its 
annual  dinner  workshops  for  medical  assistants  in 
the  counties  of  Cook,  Kane,  Will,  Lake,  DuPage, 
Winnebago  and  Lee. 

As  part  of  the  ongoing  Professional  Relations  pro- 
gram, for  thirteen  years  Blue  Shield  has  sponsored 
dinner  meetings  for  medical  assistants  to  help  keep 
them  abreast  of  changes  in  Blue  Shield  structures, 
procedures  and  methods,  and  to  help  them  carry 
out  their  responsibilities  more  effectively  for  their 
physician  employers. 

The  program  following  dinner  will  include  a new- 
ly developed  slide  presentation  showing  our  Blue 
Shield  Plan  offices  and  the  steps  that  are  taken  to 
get  a claim  paid  from  the  time  it  is  mailed  from  the 
doctor’s  office  to  the  time  that  a check  is  mailed  to 
the  doctor’s  office.  The  presentation  will  also  in- 
clude processing  of  Medicare  claims,  showdng 
various  departments  at  work.  Following  the  shde 
presentation  trained  members  of  the  Professional 
Relations  Department  will  be  available  to  answer 
questions  relating  to  Blue  Shield  and  Medicare. 

Invitations  to  attend  one  of  the  dinner  workshops 
will  be  mailed  to  all  medical  assistants  in  the  seven 
county  area  and  reservations  should  be  returned 
promptly  if  they  plan  to  attend. 

Dinners  are  served  at  6:30  P.M.  and  meetings  ad- 
journ at  9:00  P.M.  The  following  dinner  meetings 
have  been  scheduled: 


Date  Place 


Area 


Sept.  24  Ramada  Inn,  Hinsdale 
Sept.  30  Ramada  Inn,  Dolton 
Oct.  7 Windermere  Hotel 
Oct.  14  Henrici’s,  Rockford 
Oct.  15  Ramada  Inn,  Dixon 
Oct.  21  Oak  Park  Arms,  Oak  Park 
Oct.  22  Marriott  Motor  Inn 
Oct.  28  Lexington  House 
Nov.  4 Arlington  Park  Towers 
Nov.  5 Green  Tree  Inn,  Bensenville 
Nov.  11  Hyatt  House 
Nov.  18  Knickerbocker  Hotel 
Nov.  19  Knickerbocker  Hotel 


DuPage  County 
South  Suburban 
Southeast  Chicago 
Winnebago  County 
Lee  County 
Chicago 

Northwest  Chicago 
Southwest  Chicago 
Northwest  Suburban 
West  Central 
Northwest  Chicago 
Near  North 
Near  North 


For  additional  information,  please  write  or  tele- 
phone Mrs.  Loretta  O’Donnell,  Professional  Rela- 
tions Representative,  Professional  Relations  Depart- 


In  1969  Blue  Shield  organized  a new  Community 
Affairs  Department  to  make  its  resources  available 
in  the  public  service.  Who  needed  us?  Almost 
everyone,  it  seemed.  Already,  as  a community  ser- 
vice, we  were  concerned  with  our  over-65  citizens, 
administering  the  medical-surgical  portion  (Part  B) 
of  Medicare  in  the  metropolitan  Chicago  area.  We 
have  talked  with  our  young  people,  too,  alerting 
them  and  individuals  of  all  ages  to  the  dangers  of 
drug  abuse.  To  begin  with,  and  through  the  gener- 
ous cooperation  of  many  TV  stations  throughout  the 
state,  we  have  shown  three  drug  abuse  documen- 
taries, followed  by  live  interviews  with  experts  in 
this  field.  Next  we  distributed  a booklet  to  more 
than  100,000  persons  entitled  “Adolescence  for 
Adults”,  to  help  parents  understand  their  youngsters 
a little  better.  To  further  help  combat  the  drug 
abuse  problem.  Blue  Shield  is  participating  with 
law  enforcement  agencies,  schools  and  churches  by 
providing  films  and  literature.  Over  1,000  screenings 
of  the  documentaries  were  held  and  1 million  book- 
lets were  distributed  in  1969.  Blue  Shield  is  also  at 
work  in  the  organization  of  voluntary  blood  collec- 
tion programs  to  benefit  all  citizens.  Blue  Shield  is 
involved  in  a number  of  community-based  programs 
to  encourage  a higher  level  of  health  care  among  all 
socio-economic  levels.  Just  as  important,  this  kind 
of  service  is  Blue  Shield’s  primary  aim  in  its  news- 
paper, TV  and  radio  advertising  to  the  public. 

The  Model  Cities  program  is  another  example  of 
Blue  Shield’s  concerned  involvement  in  community 
needs.  In  December  1969,  a contract  was  drawn 
with  the  City  of  Chicago  to  conduct  a health-financ- 
ing study  in  the  four  Model  Cities  Communities  of 
Lawndale,  Woodlawn,  Crand  Boulevard  and  Up- 
town. The  study  is  one  of  52  separate  projects  un- 
dertaken by  the  Department  of  Housing  and  Urban 
Development  to  improve  living  conditions  for  dis- 
advantaged citizens.  Blue  Shield  welcomes  the  op- 
portunity to  participate  in  community  activities.  We 
are  involved. 


ment,  Blue  Shield  Plan  of  Illinois  Medical  Service, 
222  North  Dearborn  Street,  Chicago,  Illinois  60601. 
Telephone  (312)  661-2964. 


(This  is  not  an  advertisement) 


ASK  BLUE  SHIELD 

• • • ABOUT  MEDICARE 

Who  Performed  The  Service 

Before  a Medicare  claim  can  be  paid,  it  is  neces- 
sary to  have  the  name  of  the  physician  who  person- 
ally provided  the  service.  This  may  be  indicated  on 
the  SSA  1490  “Request  for  Payment”  form,  or  it 
may  be  included  on  an  itemized  statement  you  pro- 
vide your  patients.  For  those  of  you  who  complete 
the  SSA  1490  “Request  for  Payment”  form  for  your 
patients,  or  accept  an  assignment.  Blue  Shield  as 
Part  “B”  Carrier  in  the  five  county  area  of  Cook, 
Kane,  Lake,  Will  and  DuPage  is  willing  to  provide 
you  with  1490  forms  preprinted  with  your  name  and 
address. 

Those  physicians  who  do  not  use  the  preprinted 
forms  should  indicate  in  item  number  8 of  the 
“Request  for  Payment”  their  full  name  and  the  ad- 
dress. 

We  often  have  to  delay  processing  claims  which 
could  otherwise  be  avoided  if  complete  information 
had  been  provided.  A common  reason  for  delay  re- 
sults from  an  itemized  statement  submitted  by  the 
Medicare  beneficiary  on  letterhead  listing  more 
than  one  physician  and  when  the  physician  who 
had  provided  the  service  is  not  identified.  When  this 
occurs,  it  is  necessary  for  one  of  our  Blue  Shield 
representatives  to  contact  you  or  your  oflBce  assistant 
by  telephone  or  letter  to  obtain  the  necessary  infor- 
mation in  order  to  make  payment. 

Delays  resulting  from  such  omissions  can  be 
avoided  and  payments  speeded  by  providing  us 
with  the  name  of  the  physician  who  performed  the 
service. 

Payments  To  Group  Practices 

The  Social  Security  Administration  has  devel- 
oped procedures  to  be  applied  by  the  Part  “B”  Car- 
rier when  a group  of  physicians  practicing  together 
wishes  to  have  Medicare  payments  made  in  the 
group’s  name  rather  than  to  individual  physician 
members. 

If  all  members  of  the  group  charge  the  same  fees 
for  similar  services,  they  have  in  effect  established 
a “usual  fee”  for  the  group  which  will  be  used  as 
the  basis  of  making  Medicare  payments. 

When  fees  for  similar  services  vary  among  the 
group  members,  an  average  (the  median)  of  the 
combined  charges  will  be  used  to  determine  the 
usual  fee  for  the  group. 

If  groups  within  the  five  county  area  of  Cook, 
Kane,  Lake,  Will  and  DuPage  wish  to  have  Medi- 
care payments  made  on  this  basis,  contact  the  Pro- 
fessional Relations  Department  of  Illinois  Blue 
Shield,  222  North  Dearborn  Street,  Chicago,  Illi- 
nois 60601. 


When  You 
Accept  Assignment 

when  a physician  accepts  a Medicare  assignment 
for  his  charges,  he  may  not  bill  the  patient  for 
charges  disallowed  for  being  higher  than  “usual 
and  customary.” 

This  is  explained  on  the  reverse  side  of  the  form 
1490,  “Request  for  Payment”  which  states,  “If  you 
and  your  doctor  agree.  Medicare  will  pay  him  di- 
rectly. . . . Under  this  method  the  doctor  agrees  to 
accept  the  charge  determination  of  the  Medicare 
carrier  as  the  full  charge.  . .”  It  is  also  explained  in 
Medicare,  A Reference  Guide  to  Physicians,  pub- 
lished by  the  Department  of  Health,  Education,  and 
Welfare,  Social  Security  Administration,  page  22. 

The  physician  may,  however,  bill  the  patient  for 
any  unmet  portion  of  the  annual  $50.00  deductible, 
20%  (co-insurance)  of  the  “reasonable  charge”,  and 
any  charge  disallowed  as  non-covered  services  un- 
der Part  B Medicare. 

When  the  physician  and  his  patient  agree  to  an 
assignment,  the  patient  must  sign  the  “Request  for 
Payment”  form  unless  the  patient  is  deceased  or  is 
a Public  Aid  Recipient.  The  physician  must  also 
sign  the  form  and  check  the  box  marked  “I  accept 
assignment.” 


Notice  of  Change  in  Certification 

The  Social  Security  Administration  no  longer 
considers  the  following  laboratories  certified  for 
Medicare  participation: 

West  Lawn  Medical  Laboratory 
4255  West  63rd  Street 
Chicago,  Illinois  60629 

Besley-Waukegan  Clinic 
215  North  Sheridan  Road 
Waukegan,  Illinois  60085 


Our  Government  Contracts  Division 

reports  that  Federal  Health  Insurance  benefits 
under  Title  XVHI,  Part  B of  P.L.  89-97  were  paid 
during  July  for  over  55,000  cases  in  the  counties 
of  Cook,  DuPage,  Kane,  Lake  and  Will  for  an 
amount  exceeding  $3,700,000.  For  the  year  1970 
through  July,  payments  have  been  made  on  over 
386,000  cases  for  an  amount  exceeding  $23,000,- 
000. 

The  number  of  cases  processed  in  July  under 
Part  A exceeded  74,000  with  payments  to  pro- 
viders amounting  to  more  than  $27,200,000.  For 
the  year  1970  through  July  over  479,000  cases 
have  been  processed  and  payments  to  providers 
have  exceeded  $189,000,000. 


CThis  is  not  an  advertisement) 


Smiles  speak  louder  than  words 


for  the  good  taste  of  Soyalac 

Milk-free,  hypo-allergenic  Soyalac  has  a pleasing  taste  that 
is  eagerly  accepted  by  most  infants.  It’s  similar  to  mother’s 
milk  in  composition  and  assimilation,  much  like  cow’s  milk 
in  consistency  and  completely  free  of  fibre.  Extensive  clini- 
cal data  support  Soyalac’s  value  in  promoting  growth  and 
development.  Soyalac  is  also  excellent  for  growing  children 
and  adults. 


A request  on  your  professional  letterhead  or  prescription  form 
will  bring  to  you  complete  information  and  a supply  of  samples. 


Available  in 
Concentrated  Liquid  or  Powdered 


Soyalac 


a product  of 

LOMA  LINDA  FOODS 

MEDICAL  PRODUCTS  DIVISION 

RIVERSIDE,  CALIFORNIA 
Mount  Vernon,  Ohio,  U.  S.  A. 


for  September  1970 


191 


Meeting  Memos 


Sept.  17-19 — Illinois  State  Society  of 
Radiologic  Technologists 

35th  Annual  Meeting 
Sheraton  Hotel,  Chicago 

Sept.  18-19 — American  College  of  Phy- 
sicians 

Scientific  meeting— Internal  medicine 
The  Abbey,  Fontana,  Wise. 

Sept.  19-20 — American  Medical  Associ- 
ation 

3rd  National  Congress  on  Medical  Ethics 
Ambassador  West  Hotel,  Chicago 

Sept.  24 — American  Society  for  Testing 
and  Materials 

Organizational  meeting  of  Committee  on  Forensic 
Sciences 

ASTM  Headquarters,  Philadelphia 

Sept.  24-27 — American  College  of  Phy- 
sicians 

Scientific  meeting— internal  medicine 
Otsego  Ski  Club,  Gaylord,  Mich. 

Sept.  26-30 — American  Fracture  Asso- 
ciation 

Annual  meeting 
Americana  Hotel,  New  York 

Sept.  28 — Illinois  Registry  of  Anatomic 
Pathology 

Special  seminars 
Hektoen  Institute,  Chicago 

Sept.  30-Oct.  1 — American  Medical  As- 
sociation 

30th  Annual  Congress  on  Occupational  Health 
Century  Plaza  Hotel,  Los  Angeles,  Calif. 


Sept.  30-Oct.  3— Association  of  Ameri- 
can Physicians  and  Sur- 
geons 

Annual  Meeting 

John  Marshall  Hotel,  Richmond,  Va. 

Oct.  2 — The  Cleveland  Clinic  Education- 
al Foundation 

Postgraduate  course— medical  technology 
2020  E.  93rd  St.,  Cleveland,  Ohio 

Oct.  5-9 — American  Academy  of  Oph- 
thalmology and  Otolaryn- 
gology 

Annual  Meeting 

Dunes  Hotel,  Las  Vegas,  Nev. 

Oct.  7 — Forest  Hospital 

Demonstration  course  on  "The  Group  Psychothera- 
pies’’ 

Forest  Hospital,  Des  Plaines,  111. 

Oct.  9 — Chicago  Surgical  Society 

17th  Annual  Dinner 

Cathedral  Hall,  University  Club  of  Chicago 

Oct.  12-16 — American  College  of  Sur- 
geons 

56th  Annual  Clinical  Congress 
Chicago 

Oct.  18-23 — American  College  of  Emerg- 
ency Physicians 

2nd  Scientific  Assembly 
Las  Vegas,  Nev. 

Feh.  27-28,  1971 — American  Board  of 
Family  Practice 

Second  examination  for  certification 

University  of  Kentucky  Medical  Center,  Lexington, 

Ky. 


Six  Moon  Steps  for  Communities 

Businessmen  and  organizations  concerned  with  attacking  community 
problems  effectively  can  learn  something  from  the  six  steps  our  govern- 
ment took  in  approaching  the  problem  of  how  to  land  a man  on  the  moon. 

These  are  the  steps  pointed  out  by  Arch  N.  Booth,  executive  vice  presi- 
dent of  the  Chamber  of  Commerce  of  the  United  States: 

1.  Make  an  exhaustive  study  of  every  aspect  of  the  problem. 

2.  Agree  on  what  is  available  to  meet  the  needs  outlined;  what  can 
be  done,  and  by  whom. 

3.  Decide  in  advance  not  to  be  intimidated  by  the  magnitude  of  the 
task,  its  expense,  or  the  time  and  effort  required  to  perform  it. 

4.  Set  up  an  adequate  organization  of  competent  people. 

5.  Resolve  to  refuse  to  be  stampeded  into  shortcuts  or  unrealistic  time 
schedules. 

6.  Build  into  the  program  the  capacity  to  rebound  from  failure,  and 
to  analyze  and  learn  from  mistakes. 


192 


Illinois  Medical  Jourtial 


Drip  stopped,  Congestbn  cieared 


For  upper  respiratory  allergies  and  infections,  up  to 
12  hours  clear  breathing  on  one  tablet.  Dimetapp 
Extentabs®  does  an  outstanding  job  of  helping  to  clear 
up  the  stuffiness,  drip  and  congestion  of  colds  and  up- 
per respiratory  allergies  and  infections.  Each  Extentab 
keeps  working  up  to  12  hours.  And  for  most  patients 
drowsiness  or  overstimulation  is  unlikely. 
INDICATIONS:  Dimetapp  is  indicated  for  symptomatic 
relief  of  the  allergic  manifestations  of  respiratory  ill- 
nesses, such  as  the  common  cold  and  bronchial  asthma, 
seasonal  allergies,  rhinitis,  conjunctivitis,  and  otitis. 
CONTRAINDICATIONS:  Hypersensitivity  to  antihista- 
mines. Not  recommended  for  use  during  pregnancy. 


PRECAUTIONS:  Until  patient’s  response  has  been  de- 
termined, he  should  be  cautioned  against  engaging  in 
operations  requiring  alertness.  Administer  with  care  to 
patients  with  cardiac  or  peripheral  vascular  diseases  or 
hypertension.  SIDE  EFFECTS:  Hypersensitivity  reac- 
tions including  skin  rashes,  urticaria,  hypotension  and 
thrombocytopenia,  have  been  reported  on  rare  occa- 
sions. Drowsiness,  lassitude,  nausea,  giddiness,  dry- 
ness of  the  mouth,  mydriasis,  increased  irritability  or 
excitement  may  be  encountered.  /I-H-DOBINS 
DOSAGE:1  Extentab  morning  and  eve-  l\ 

A.  H.  Robips  Compapy 

ning.SUPPLIED:Bottlesof  100  and  500.  Richmond.  Va.  23220 


Ditneta 


Dimetane®  (brompheniramine  maleate).  12  mg.;  phenyl- 
ephrine HCt.  15  mg.;  phenylpropanolamine  HCI.  15  mg. 


J.  Ernest  Breed 


The 

President’s 

Page 


Practicing  physicians  are  in  short  supply 


Everyone  talks  of  the  shortage  of  doctors, 
and  the  medical  society  as  well  as  many 
other  groups  are  making  frantic  efforts  to 
increase  the  number  graduating  from  med- 
ical schools.  Since  we  have  about  one  doctor 
for  every  750  people  in  the  United  States 
it  appears  there  should  be  no  shortage,  but 
everyone  knows  there  is  a shortage  of  prac- 
ticing physicians.  It  seems  too  many  doctors 
take  jobs  with  insurance  companies,  indus- 
trial concerns,  or  work  as  administrators 
of  medical  schools,  hospitals,  medical  so- 
cieties or  other  organizations.  Many  are 
doing  research  or  teaching.  Many  older 
doctors  have  retired  from  active  practice. 
None  of  these  doctors  are  taking  care  of 
sick  patients. 

Late  this  spring  the  Illinois  State  Medical 
Society  sent  a cjuestionnaire  to  a total  of 
5,000  Illinois  medical  school  students,  in- 
terns and  residents.  The  questionnaire  was 
designed  to  learn  their  plans  for  the  future. 
They  weie  asked  if  they  plan  to  practice 
medicine  and  if  so,  where  and  how.  They 
were  asked  about  research,  specialization, 
general  practice  and  if  they  planned  to 
practice  solo  or  to  join  a group.  We  are 
expending  gieat  effort  to  encourage  the 
medical  schools  to  graduate  more  general 
practitioners  and  are  encouraging  young 
doctors  to  go  to  the  smaller  towns  in  Illi- 
nois. We  were  eager  to  learn  if  our  efforts 
are  going  to  be  successful. 

We  were  also  stimulated  to  question  our 
successors  since  a similar  questionnaire 
sent  to  students  from  an  eastern  school  dis- 
closed that  only  60%  planned  to  practice 
medicine,  while  40%  were  going  into  re- 
search, administration  or  teaching. 


Of  the  5,000  questionnaires  we  sent  out, 
a total  of  1,396  were  returned.  Five  hun- 
dred and  ninety-four  were  from  students, 
252  from  interns  and  550  from  residents, 
l ire  results  will  be  the  subject  of  a series 
of  future  articles  in  the  Journal.  A pre- 
view discloses  about  95%  of  those  returning 
the  cjuestionnaire  jrlan  to  practice  medicine 
and  67%  of  these  join  a group.  Of  great 
significance  is  the  fact  that  14%  of  the 
students  jDlan  to  do  family  practice,  but 
only  1.4%  of  residents  hold  this  plan.  One 
wonders  what  happens  to  them  between 
their  student  clays  and  their  residencies. 

In  the  jrast,  about  60%  of  our  own  grad- 
uates stayed  in  Illinois  and  of  those  resi- 
dents answering  the  survey,  about  the  same 
number  jrlan  to  stay  in  the  state.  One  dis- 
turbing discovery  is  that  63%  of  those  who 
j)lan  to  stay  in  Illinois  jrlan  to  jrractice  in 
Chicago.  The  jrojmlations  of  Cook  County 
and  clownstate  are  about  equal,  still  Chi- 
cagoland  now  has  twice  as  many  physi- 
cians as  jjractice  in  the  rest  of  the  state. 
From  the  answers  of  the  residents  one 
woidtl  believe  this  jrrojrortion  would  con- 
tinue. 

Perhaps  those  who  do  not  plan  to  prac- 
tice medicine  should  be  given  special  uni- 
versity training  outside  the  medical  schools 
making  room  for  those  who  wotdd  even- 
tually take  care  of  sick  people.  Certainly 
we  should  do  all  we  can  to  attract  young 
jrhysicians  to  areas  where  practicing  physi- 
cians are  in  short  supply. 


194 


Illinois  Medical  Journal 


Clinics  for  Crippled  Children 


1 weiuy-eight  clinics  tor  Illinois’  physi- 
cally handicapped  children  have  been 
schechded  lor  October  by  the  University  ol 
Illinois,  Division  of  Services  for  Crippled 
Children.  The  Division  will  count  twenty- 
one  general  clinics  providing  diagnostic 
orthopedic,  pediatric,  speech  and  hearing 
examination  along  with  medical  social, 
and  nursing  service.  There  will  be  five  spe- 
cial clinics  for  children  with  cardiac  con- 
ditions and  rheumatic  fever,  and  two  for 
children  with  cerebral  palsy.  Clinicians 
are  selected  from  among  private  physicians 
who  are  certified  Board  members.  Any 
private  physician  may  refer  to  or  bring  to 
a convenient  clinic  any  child  or  children 
for  whom  he  may  want  examination  or 
(onsnitativc  services. 

October  6 Carrollton— Boyd  Memorial  Hos- 
pital 

October  7 Metropolis— Massac  Memorial 
Hospital 

October  7 Hinsdale— Hinsdale  Sanitarium 
October  7 Rock  Island  Cerebral  Palsy— 
3808  Eighth  Avenue 

October  8 Lake  County  Cardiac— Victory 
Memorial  Hospital 

October  8 Rockford— St.  Anthony  Hosjtital 
October  8 Flora— Clay  County  Hospital 
October  8 Springfield  General— St.  John’s 
Hospital 

October  8 Cairo— Public  Health  Dejtart- 
ment 

Octobei  9 Chicago  Heights  Cardiac— St. 
James  Hospital 

October  13  Rock  Island  Area  General— 
Moline  Public  Hospital 
October  13  Peoria— St.  Francis  Children’s 
Hospital 

October  13  East  St.  Louis— Christian  Wel- 
fare Hospital 

October  13  Quincy— Blessing  Hospital 
October  14  Champaign-Urbana— McKinley 
Hospital 


October  15  Bloomington— St.  Joseph’s  Hos- 
pital 

October  15  Elmhurst  Cardiac— Meimnial 
Hospital  of  DuPage  County 
October  21  Chicago  Heights  General— St. 
James  Hospital 

October  23  Chicago  Heights  Caidiac— St. 
James  Hospital 

October  23  Evanston— St.  Francis  Hospital 
October  26  Peoria  Cardiac— St.  Francis 
Children’s  Hospital 

October  27  Peoria— St.  Francis  Children’s 
Hospital 

October  27  East  St.  Louis— Christian  Wel- 
fare Hospital 

October  27  Danville— Lake  View  Hospital 
October  28  Centralia— St.  Mary’s  Hospital 
October  28  Aurora— Copley  Memorial  Hos- 
pital 

October  28  Springfield  Pediatric  Neurology 
—Diocesan  Center 

October  28  Mt.  Vernon— Good  Samaritan 
Hospital 

The  Division  of  Services  for  Crippled 
Children  is  the  official  state  agency  estab- 
lished to  provide  medical,  surgical,  correc- 
tive, and  other  services  and  lacilities  for 
diagnosis,  hospitalization  and  after-care 
for  children  with  crippling  conditions  or 
who  are  suffering  from  contlitions  that  may 
lead  to  crippling. 

In  carrying  on  its  program,  the  Division 
works  cooperatively  with  local  medical  so- 
cieties, hospitals,  the  Illinois  Children’s 
Hospital-School,  civic  and  fraternal  clubs, 
visiting  nurse  association,  local  social  and 
welfare  agencies,  local  chapters  of  the  Na- 
tional Foundation  and  other  interested 
groups.  In  all  cases,  the  work  of  the  Divi- 
sion is  intended  to  extend  and  supplement, 
not  supplant  activities  of  other  agencies, 
either  public  or  private,  state  or  local,  car- 
ried on  in  behalf  of  crippled  children. 


Rebels  Are  Muzzled  First  After  Rebellion 

"If  we  permit  campus  minorities  to  foist  their  own  biases  on  the  university 
and  push  it  into  conflict  with  the  fundamental  values  of  our  society,  institu- 
tional autonomy  will  soon  be  taken  away  by  the  public  that  supports  and 
ultimately  controls  higher  education.  The  first  members  of  the  academic  com- 
munity to  be  muzzled  by  outside  forces,  furthermore,  would  be  those  who  now 
wish  to  politicize  it."— Dr.  Logan  Wilson,  president,  American  Council  on  Education. 


for  September  1970 


197 


Some  days  she  can't  seemi 
\iiSk  to  function. 


Abstracts  Of  Board  Actions 

Board  of  Trustees  Meeting 

July  18-19,  1970 

Arlington  Towers,  Arlington  Heights 

These  abstracts  are  published  so  that  members  of  the  Illinois  State  Medical  Society  may 
keep  advised  of  the  actions  of  the  Board  of  Trustees.  It  covers  only  major  actions  and  is 
not  intended  as  a detailed  report.  Full  minutes  of  the  meetings  are  available  upon  any 
member’s  request  to  the  headquarters  office  of  the  ISMS. 

Continuing  Education 

In  conjunction  with  the  program  in  continuing  education  being 
developed  by  Dr.  George  Miller,  University  of  Illinois,  the 
Board  approved  formation  of  the  proposed  committee  on  continu- 
ing education.  This  is  to  be  developed  with  an  initial  group  of 
eight  persons,  four  from  the  University  of  Illinois  and  four 
from  ISMS,  on  an  ad  hoc  basis,  to  develop  preliminary  plans. 
In  subsequent  discussion  the  Board  took  action  to  recommend  that 
a representative  of  each  Illinois  medical  school  be  invited  to 
the  initial  meeting  scheduled  for  July  27.  Appointed  as  the 
ISMS  members  of  the  committee  were  Drs.  Breed,  Cannady,  Gibbs 
and  Dean  Bordeaux  (Vice-chairman,  ISMS  Committee  on  Continuing 
Education) . 

Foundations  for  Medical  Care 

This  relatively  new  concept  in  the  provision  of  health  serv- 
ices was  felt  to  be  a subject  of  great  importance.  The  Board 
instructed  the  Committee  on  Health  Care  Financing  (formerly  the 
Committee  on  Usual  and  Customary  Fees)  to  make  a thorough  study 
of  the  possibilities  and  ramifications  of  such  foundations  and 
report  at  the  next  Board  meeting. 

In  action  taken  after  an  initial  meeting  of  the  Committee  on 
Health  Care  Financing,  the  Board  adopted  the  committee  rec- 
ommendation recognizing  the  concept  of  these  foundations,  in 
philosophy,  as  another  means  of  health  care  delivery. 

Peer  Review 

A booklet  of  guidelines  for  Peer  Review  Committees,  incorpor- 
ating minor  changes  from  previously  approved  guidelines,  was 
approved.  The  Board  directed  that  all  counties  be  apprised  of 
procedures  to  be  followed  and  that  the  booklet  be  made  available 
to  them.  Each  Trustee  was  urged  to  work  with  the  counties  in  his 
district  to  set  up  Peer  Review  mechanisms  and  to  ensure  that 
all  Peer  Review  cases  are  handled  in  the  most  expeditious  manner. 

ISMS/CMS  Joint  Convention  Planning 

Acting  upon  the  report  of  the  Executive  Committee  and  a joint 
planning  committee,  preliminary  plans  for  a combined  ISMS/CMS 
meeting  were  approved.  Subsequent  to  actions  of  the  House  of 
Delegates,  meetings  have  been  held  to  accomplish  combination 
of  the  CMS  Clinical  Conference  and  the  ISMS  Annual  Meeting. 
These  meetings  included  representatives  from  ISMS  and  CMS,  and 
initially  accepted  recommendations  include: 


for  September  1970 


207 


The  name  of  the  meeting  may  be  Annual  Midwest  Clin- 
ical Conference  (jointly  sponsored  by  ISMS  and  CMS, 
with  cooperating  participating  specialty  societies) . 

There  would  be  joint  management  of  the  meeting, 
likely  scheduled  in  March,  beginning  in  1972. 

The  House  of  Delegates  and  the  Auxiliary  will  meet 
concurrently  with  the  clinical  sessions.  Further 
plans  will  be  announced. 

Hospital  Relations  and  Reimbursement 

A bill  recently  defeated  in  the  Illinois  legislature,  SB 
1145,  would  have  extended  state  control  over  hospital  additions 
and  expansions.  The  bill  also  dealt  with  hospital  planning 
agencies  and  was  a prime  recommendation  of  the  Advisory  Com- 
mittee on  Medical  Costs  and  Utilization  of  Services.  The  ISMS 
House  of  Delegates  passed  resolution  70M-50,  which  covers  rate 
negotiation  as  a preferred  method  of  hospital  reimbursement 
from  government  and  carriers.  The  Advisory  Committee  also  rec- 
ommended this  and  70M-50  is  related  to  SB  1145  since  rate  ne- 
gotiation can  be  used  to  bring  financial  responsibility  into 
hospital  operation  and  give  impetus  to  hospital  planning. 

The  Board  appointed  a special  ad  hoc  committee  to  study  this 
matter.  Appointed  were  Drs.  Jirka  (chairman),  Lees  and  O'Don- 
nell. They  will  involve  such  council  and  committee  chairmen  as 
necessary,  to  avoid  duplication  of  effort. 

Consumer  Advisory  Panel 

Due  to  the  recognized  need  for  education  of  the  public  in  mat- 
ters of  health,  health  care  delivery  and  personal  care,  the 
Board  authorized  establishment  of  a consumer  advisory  panel. 
Members  will  be  appointed  to  this  upon  recommendation  of  the 
Task  Force  on  Physician  Shortage  and  Services  to  Medically  De- 
prived Areas.  The  Task  Force  will  establish  the  framework  within 
which  the  panel  will  operate. 

Reduction  of  State  Laboratory  Services 

A letter  to  the  governor,  regarding  actions  taken  in  reducing 
laboratory  services  for  budgetary  reasons  was  authorized.  The 
letter  was  to  request  that  in  the  future  such  measures  that  af- 
fect medical  care  in  Illinois  be  discussed  with  ISMS  before  being 
announced. 

Professional  Licensing  Policies 

Dr.  Albert  Glass,  director  of  the  Department  of  Mental  Health, 
met  with  the  ISMS  Council  on  Mental  Health  and  Addiction  to 
discuss  concerns  about  manpower  shortages  in  the  Department. 
Dr.  Glass  was  present  to  discuss  these  with  the  Board  as  part  of 
Dr.  Falk's  Council  report.  The  Council  reported  on  licensing 
policies  of  the  Department  of  Registration  and  Education  and 
recommended  that  physicians  who  are  certified  by  the  American 
Board  of  Psychiatry  and  Neurology  and  are  licensed  in  another 
state,  be  licensed  in  Illinois  upon  written  request  by  the  Di- 
rector of  the  Department  of  Mental  Health.  It  was  further  rec- 

(Conlimicd  on  page  274) 


20.' 


Illinois  Medical  Joiunal 


volume  138,  number  3 


September,  1970 


Arteriography : 

Principles  and  techniques 


By  Paul  B.  Savory,  M.D. /Chicago 


The  last  decade  of  radiology  has  seen 
the  introduction  of  what  is  commonly  re- 
ferred to  as  “Special  Procedures.”  While  in 
fact  the  whole  discipline  of  radiology  is 
really  one  of  the  application  of  special  pro- 
cedures, its  enlargement  by  the  addition  of, 
amongst  others,  arteriography  is  the  subject 
of  this  writing.  The  experience  and  the 
development  of  certain  dictums,  though 
subject  to  change,  are  presented  in  the 
hope  that  an  interchange  of  ideas  will  furth- 
er add  to  the  usefulness  as  well  as  limita- 
tions of  this  procedure. 

Forsmann  was  the  first  to  introduce  a 
catheter  into  the  vascular  system  in  vivo 
of  the  human  in  1928.  He  performed  this 
upon  himself,  which  must  have  required 
considerable  confidence,  as  well  as  fore- 
sight. Moniz,  in  1928,  performed  carotid 
arteriographies  of  amazingly  good  quality. 
All  of  this  only  goes  to  demonstrate  that  the 
early  pioneers  in  radiology  were  not  only 
ambitious  but  well  qualified  in  their  work. 

Arteriography  in  radiology  obtained  a 
great  impetus  as  the  result  of  several  de- 
velopments. Mention  must  be  made  of  Sel- 
dinger  in  Sweden,  who  in  1953,  introduced 
an  acceptably  safe  and  successfully  repeti- 
tive technique  of  introducing  catheters  in- 


to the  vascular  system  by  a closed  method.^ 
Contrast  material  development  largely 
belongs  to  pharmacology.  All  types  to 
date  employ  the  use  of  the  element  io- 
dine, in  various  states  of  chemical  com- 
bination with  other  elements  to  produce  a 
substance  of  sufficient  solubility,  low  vis- 
cosity, and  reduced  toxicity  to  enable  its 
use  in  the  living  being.  Moniz  injected 
strontium  bromide  and  sodium  iodide.  Dio- 
drast  and  urokon  were  used  extensively  but 
suffer  from  high  toxicity  in  volumes  used 
in  living  beings.  Thorotrast  provides  good 
contrast,  and  while  non-toxic,  it  is  radio- 
active. It  is  not  used  routinely.  With  the 
introduction  of  the  methyl  salts  of  these 


Paul  B.  Savory,  M.D.,  main- 
tains a private  practice  in 
radiology  and  is  on  the  staffs 
o f Presbyterian-St.  Luke’s 
Hospital  and  the  University 
of  Illinois  in  that  capacity. 

He  received  his  M.D.  degree 
from  McGill  University  and 
served  his  internship  at  the 
Royal  Victoria  Hospital  in  Montreal,  Quebec, 
and  his  residency  at  Preshyterian-St.  Luke’s 
Hospital. 


for  September  1970 


215 


Fig.  1.  The  equipment  usually  employed  for  aortography  and  selective  arteriography. 


compounds,  toxic  reactions  have  been  mark- 
edly reduced.  Recently,  the  intravascular 
use  of  dextran  has  been  shown  to  reduce, 
in  particular,  the  cerebral  reactions  to  io- 
dinated  compouncls.- 

Engineers  and  the  manufacturers  of  X- 
ray  equipment  have  played  an  important 
role  in  the  field  of  arteriography.  The  event 
that  is  to  be  visualized  in  arteriography  is 
for  the  most  part  rapid  and  is  composed 
of  more  than  one  compoirent.  Thus,  the 
need  for  a rapid  production  of  consecutive 
films  is  the  optimum.  The  producers  of 
ecjuipment  have  responded  well  through 
the  years  to  the  needs  of  the  radiologist. 
Equipment  is  now  available  and  reliable 
for  the  rapid  serial  filming,  producing  good 
detail  and  acceptable  levels  of  safety. 

Of  more  recent  times,  there  has  been  a 
rash  of  activity  in  the  development  and 
improvement  of  kinds,  types  and  sizes  of  the 
catheter  materials.  Further  attention  to  this 
will  be  given  later  in  this  paper. 

Patient  Evaluation 

The  purpose  of  radiology  is  to  supply  as 
much  information  as  possible  about  the  pa- 
tient, therefore  the  more  the  radiologist 
knows,  the  more  he  can  tell.  Evaluation 
of  the  patient  prior  to  arteriography  be- 
comes paramount.  The  history,  physical 
and  all  prior  studies  are  reviewed  careful- 
ly, not  only  to  determine  whether  the  study 
can  be  clone  but  also  in  what  manner;  a 
decision  which  involves  the  least  risk  to 
the  patient  and  the  greatest  degree  of  in- 
formation to  the  physician. 

Special  attention  is  given  to  the  patient’s 
arterial  system.  It  goes  without  saying  that 
an  artery  that  is  not  palpated  cannot  be 


easily  catheterized.  Arteries  are  subject  to 
diseases  which  may  affect  the  procedure. 
Occlusive  disease  and  atherosclerosis  are  of 
special  concern  to  the  radiologist.  It  has 
been  our  policy  to  avoid  puncture  of  any 
artery,  in  which  by  history  or  physical  there 
is  either  present  or  an  impending  possibility 
of  precipitating  arterial  obstruction.  Like- 
wise, the  patient’s  peripheral  vessels  are 
palpated  and  marked  prior  to  any  proced- 
ure; these  marked  vessels  are  used  following 
the  procedure  to  control  the  hemorrhage 
from  the  puncture  site  and  to  assist  in  eval- 
uation of  post  procedure  thrombosis. 

A history  of  sensitivity  to  the  contrast 
material  is  sought.  In  our  experience,  there 
has  been  a lower  incidence  of  reactions 
when  contrast  is  intra-arterially  introduced 
as  compared  to  intravenous  injection.  Spec- 
ulation exists  whether  this  decrease  is  the 
result  of  the  material  having  to  pass 
through  tissues  and  thus,  being  dispersed 
before  being  delivered  to  the  brain  or 
whether  the  role  of  preoperative  medica- 
tion is  responsible. 

Very  few  patients  are  currently  accepted 
for  arteriography  as  an  out-patient  pro- 
cedure. T hese  examinations  are  usually  re- 
stricted to  a simple  puncture  for  femoral 
arteriography  and  no  pre-medication  is  giv- 
en. Most  studies  are  on  in-patients  and  med- 
ication is  given  prior  to  the  examination, 
consisting  of  Demerol  75  mg.,  Phenergan  25 
mg.,  and  Seconal  100  mg.,  unless  otherwise 
indicated.  Children  and  infants  are  well 
handled  with  Demerol  1 mg/kg,  Thorazine 
1 mg/kg.  Nembutal  5 mg/kg.  Atropine  up 
to  15  lbs.,  .05  mg.,  15-40  lbs.  1 mg.,  40-75 
lbs.  2 mg. 

The  examination  is  considered  and  treat- 


216 


Illinois  Medical  Journal 


ed  as  a consultation.  A full  report  is  put 
on  the  patient’s  record  as  well  as  a copy 
for  the  radiology  department.  The  patient 
is  visited  following  the  procedure  as  well 
as  the  following  day  and  any  complications 
or  adverse  reactions  are  noted  in  the  rec- 
ords. 

Equipment 

The  personnel  in  the  department  are 
trained  to  maintain  and  set  up  the  equip- 
ment trays  and  tables.  In  addition  to  the 
equipment  required  for  the  injection  of 
contrast  material,  the  set-up  includes  need- 
les and  syringes  for  the  local  anesthesia, 
syringes  for  flushing  the  catheter,  etc.  A 
typical  set  is  shown  in  Figure  1. 

The  needles  for  femoral  or  axillary  punc- 
ture are  of  two  sizes,  .035”  and  .045”,  in- 
ternal diameter  (I.D.).  They  are  usually  re- 
ferred to  as  Seldinger  needles,  and  are  com- 
posed of  an  outer  sheath  upon  which  is  a 
controllable  flange.  There  is  an  inner  cut- 
ting needle  with  a bore  and  finally  a sharp 
stilette.  (Fig.  2.) 


As  a source  of  confusion,  numbers  of 
various  dimensions  have  been  used  to  in- 
dicate sizes  of  needles,  wires,  catheters,  etc. 
The  term  PE  205  and  PE  160  are  not  meas- 
urements, but  are  arbitrary  production 
numbers  of  the  manufacturer.  (Graphs  1 
and  2.) 

The  two  graphs  show  the  relationship  be- 
tween inches,  centimeters  and  Erench  sizes. 
It  should  be  remembered  that  one  must  re- 
fer these  figures  to  the  inner  and  outer  di- 
ameters of  objects.  In  general  it  is  felt  that 
outer  diameters  are  the  more  important 
reference  point,  since  it  is  this  size  that  is 


compromising  the  luminal  capacity  of  any 
vessel. 

The  guide  wires  that  are  used  are  of 
several  varieties.  In  general,  we  have  pre- 
ferred the  inner  core  of  the  flexible  wires 
be  hrmly  fixed  to  the  outer  winding  at  its 
ends.  Fracturing  of  the  outer  winding  and 
loss  within  the  vascular  system  can  be  a 
serious  complication.  Again  the  wires  are 
of  the  size  corresponding  to  the  needles, 
beinar  .035”  and  .045”  outer  diameter 
(O.D.). 

Tortuosity  and  irregular  luminal  defects 
of  arteries  are  particularly  suitable  to  J- 
shaped  wires.  (Fig.  3.) 

Catheters 

The  catheters  are  either  of  polyethylene 
or  teflon,  and  vary  in  size  from  .070”  to 
.047”  inner  diameter  (I.D.).  Those  that  are 
most  commonly  used  in  this  department 
are  either  the  .070”  or  .071”  I.D.  with  an 
outer  diameter  (O.D.)  of  .109”  and  .093” 
respectively.  The  difference  in  these  latter 
two  is  obviously  wall  thick- 
ness. Though  the  latter  is 
a thin  wall,  satisfactory  de- 
livery rates  of  contrast  ma- 
terial have  been  obtained. 
Rarely  are  aortographic 
catheters  smaller  than  the 
least  of  these.  Occasionally, 
in  children,  smaller  dimen- 
sions are  utilized;  a sub- 
ject to  which  other  authors 
are  more  experienced.  The 
lengths  of  catheters  can 
vary  but  tend  to  be  stand- 
ardized at  50,  80,  and  120 
cm. 

These  catheters  are 
arranged  in  various 
shapes  and  with  side  holes,  usually  3-4  in 
number. 3 Catheter  material  is  purchased 
from  the  distributor  in  bulk  and  final  proc- 
essing and  shaping  performed  by  ourselves, 
though  there  are  no  objections  to  having 
this  performed  by  professional  persons.  We 
have  become  accustomed  to  making  the  size 
and  shape  of  loops  ourselves.  The  loops  vary 
in  diameter  according  to  the  expected  I.D. 
of  the  aorta.  Double  loops  are  formed  in 
some  for  ascending  aortographic  work. 
(Fig.  4.)  The  purpose  is  to  prevent,  as 
much  as  possible,  the  uncoiling  that  occurs 
at  the  time  of  injection.  Inadvertent  in- 


r 


Fig.  2.  Dismantled  “Seldinger  Needles”  used,  .035”  on  the  left, 
.045”  on  the  right. 


/or  September  1970 


217 


Fig.  3.  Two  guide  wires,  showing  windings. 
J-wire  on  the  right. 


jections  of  large  volumes  of  contrast  ma- 
terial into  cerebral  vessels,  coronaries  and 
intracardiac  chambers  may  create  serious 
complications.  The  loop  also  serves  to  de- 
liver the  bolus  of  contrast  material  within 
a concentrated  area. 

Some  of  the  catheters  are  shaped  specifi- 
cally for  selective  work,  thus  certain  curves 
are  designed  for  renals  and  other  abdom- 
inal vessels,  the  in-nominate,  etc.  (Fig.  5.) 
Lately,  the  authors  have  had  considerable 
success  with  the  use  of  straight  catheters 
in  association  with  an  obturator  in  aorto- 
graphic  work.  (Fig.  6.)  This  technique  is 
not  new  and  has  certain  appealing  fea- 
tures. The  obturator  is  welded  to  a long, 
thin  but  durable  wire.  The  fixation  of  the 
wire  is  external  to  the  patient.  This  elim- 
inates the  possibility  of  losing  the  obturator 
within  the  patient  in  case  of  catheter  rup- 
ture. 


Fig.  4.  Two  looped  catheters  shown.  Double 
loops  on  left  used  in  ascending  aortography. 


As  aortography  became  an  acceptably 
safe  and  informative  procedure,  interest 
grew  into  the  development  of  selective  ar- 
teriogiaphy  of  individual  arteries.  Mention 
has  been  made  of  preformed  catheters 
for  this  work.  Judkins  has  contributed  to 
this  field  in  performing  coronary  arterio- 
graphy^; others  refer  to  “head  hunter” 
catheters  for  cerebral  vascular  studies. 
These  procedures  have  the  disadvantage  of 
the  use  of  intra-catheter  wires  and  the  ne- 
cessity, on  occasion,  of  multiple  insertions 
of  preformed  catheters.  It  may  lead  to  pro- 
longation of  the  examination  and  added 
trauma  to  the  site  of  arterial  puncture. 

A very  useful  and  versatile  instrument 
has  been  introduced  as  a guided  catheter. 
Though  there  have  been  a variety  of  sys- 
tems devised,  the  one  most  successful  in 
our  hands  is  referred  to  as  the  Medi-tech 


Fig.  5.  Various  types  of  preformed  catheters  for 
selective  injections. 

system.*  It  offers  the  advantage  of  elimin- 
ating the  intra-catheter  wire  and  allows 
the  operator  to  manipulate  the  system  with 
a constant  drip  of  heparinized  saline.  This 
prevents  the  possibility  of  foreign  material 
and  blood  clot  from  being  inadvertently  in- 
jected. The  system  offers  a maximum  de- 
gree of  control  of  the  tip  of  the  catheter 
in  all  parameters.  Torque  control  by  virtue 
of  the  guide  wires  in  the  wall  of  the  cathe- 
ter eliminates  twisting  of  the  catheter  at 
the  puncture  site. 

Technique  of  Arteriography 

After  it  has  been  determined  that  a pa- 
tient would  benefit  by  the  procedure  with- 
out an  undue  risk  of  complications,  atten- 
tion is  given  to  the  most  accessible  ap- 

*Medi-Tech,  incorporated,  Belmont,  Mass. 


218 


Illinois  Medical  Journal 


proach  consistent  with  the  area  to  be  in- 
vestigated. 

The  following  remarks,  impressions,  and 
hence  principles  have  been  obtained  by 
considering  the  experience  of  other  investi- 
gators and  of  our  own  material,  consisting 
of  2,174  cases  over  a period  of  five  years. 

We  have  no  suggestions  regarding  the 
Seldinger  technique  of  arterial  puncture 
with  the  insertion  of  a flexible  wire.  The 
vessels  peripheral  to  the  puncture  are  pal- 
pated and  marked.  This  abets  the  operator 
in  caring  for  the  puncture  site  following 
the  procedure.  The  intra-arterial  wire  is 
passed  through  the  needle  and  advanced 
to  the  abdominal  aorta  under  fluroscopy 
to  make  sure  of  its  patency.  Tortuosity  and 
partial  obstructions  are  noted;  in  case  of 
the  latter,  the  J-wire  may  be  of  use.  At 
no  time  is  the  intra-arterial  wire  forced. 
Constant  fluoroscopic  visualization  is  nec- 
essary. It  is  often  discovered  that  in  elderly 
individuals  the  right  common  iliac  is  very 
tortuous  but  patent.  This  does  make  for 
difficulties  in  advancing  and  control  of  the 
catheter.  It  may  be  elected  to  use  the  left 
side  since  tortuosity  is  less  common  than 
on  the  right.  The  wire  is  then  withdrawn 
to  the  level  of  the  sacro-iliac  joint  and 
the  needle  removed,  thereby  assuring  suf- 
ficient wire  length  external  to  the  groin 
for  the  placement  of  the  catheter  without 
further  motion  of  the  wire  or  upon  the 
puncture  wound  in  the  artery.  The  cathe- 
ter is  threaded  over  the  wire  and  intro- 
duced into  the  artery.  From  the  time  the 
needle  is  removed  until  the  catheter  is  in 
the  artery,  hemorrhage  is  controlled  by 
digital  pressure. 

Having  dealt  with  catheter  insertions  in- 
to arteries,  various  technical  factors  arise 
at  different  sites  of  catheter  positions. 

Thoracic  aortography  has  a few  points 
that  need  mentioning.  Perhaps  the  highest 
incidence  of  serious  complications  occurs 
in  patients  having  ascending  aortography. 
These  are  usually  cerebral  in  nature  but 
closely  challenged  by  cardiac  problems.  In 
aortic  root  injections  it  has  been  our  intent 
to  refrain  from  crossing  the  aortic  valve 
with  any  type  of  instrumentation.  Such  an 
event  is  inviting  cardiac  arrhythmias  which 
can  be  of  serious  consequence  when  un- 
recognized and  untreated.  A position  mid- 
way between  the  aortic  root  and  origin  of 
innominate  artery  for  looped  catheters  is 
chosen.  The  exit  holes  are  directed  caudad 


Fig.  6.  Straight  catheter  with  obturator  used 
for  aortography. 

away  from  the  cardiac  structures  and  re- 
coiling is  away  from  the  origins  of  great 
vessels.  On  double  loops,  the  exit  holes  are 
in  the  first  or  proximal  loop,  usually  3-4 
in  number.  Another  point  to  mention  is 
that  the  catheter  should  be  long  enough 
to  traverse  the  tortuosity  of  the  aorta  in 
the  elderly  and  we  tend  to  push  the  cathe- 
ter into  position  so  that  the  catheter  lies 
against  the  lateral  wall  of  the  descending 
aorta  as  well  as  against  the  roof  of  the  arch 
of  the  aorta.  The  size  of  the  catheter  is 
determined  by  each  system  set  up.  We  have 
been  satisfied  with  the  deposition  of  60  cc 
of  contrast  material  within  2 sec.  This  has 
required  with  our  equipment  a French  8 
catheter  or  its  equivalent  .045-.052  I.D. 

Lately,  the  authors  have  by  virtue  of 
their  desire  to  be  rid  of  the  disadvantages 
of  loojDS,  namely  uncoiling,  intraventricular 
injection,  inadvertent  great  vessel  injection, 
and  the  difficulty  of  passing  loops  into  the 
femoral  artery,  used  the  following  system. 
The  catheter  used  is  straight  and  of  the 
size  stated  above.  There  are  multiple  side 
holes  concentrated  within  2-3  cm.  of  the 
end  of  the  catheter.  With  the  catheter 
placed  in  the  mid-ascending  aorta,  an  ob- 
turator is  passed  down  the  catheter  which 
occludes  the  end  hole.  On  injection,  the 
contrast  material  exits  from  the  side  holes 
in  a concentrated  bolus.  Due  to  the  possi- 
bility of  rupture  of  the  catheter  and  loss  of 
the  metallic  occluder  into  the  vascvdar  sys- 
tem, the  occluder  is  welded  to  a long  thin 
wire  and  the  wire  is  locked  into  position 


/or  September  1970 


219 


Fig.  7.  Examples  of  ascending  aortography  with  obturated  catheter. 


by  a vise  mechanism  external  to  the  patient. 

The  possibility  of  cardiac  complications, 
particularly  arrythmia  and/or  cardiac  ar- 
rest, have  prompted  our  procedures,  above 
the  level  of  the  diaphragm,  to  be  monitored 
by  a continuous  EKG. 

There  are  no  particular  problems  with 
descending  aortographic  jtrocedures  that 
need  mention.  As  has  been  described  by 
other  authors,  dissecting  aneurysm  is  exam- 
ined by  ascending  autography  as  described, 
but  in  addition,  a descending  aortogram  is 
performed  to  visualize  the  distal  end  of 
the  dissection  or  re-entry  point.  Not  infre- 
quently, the  dissection  extends  considerab- 
ly, making  surgery  cjuite  difficult. 

Abdominal  aortographic  procedures  have 
been  the  subject  of  discussion  by  many 
authors  and  described  adec|uately.®  Renal 


artery  disease  in  renal  hypertension  can 
be  simulated  by  catheter  or  wire  manip- 
idation  within  the  renal  artery.  Thus,  it  is 
usual  that  a “flush”  aortogram  is  obtained 
before  selection  studies  are  entertained. 
Preferably  the  films  show  no  filling  of  the 
celiac  axis  or  superior  mesenteric  artery. 
Either  a single  looped  catheter  with  the 
exit  holes  directed  in  and  down  or  a 
straight  obturated  catheter  is  employed. 
(Eig.  8.)  _ _ 

The  position  is  determined  at  fluoroscopy 
by  a small  test  injection.  A dose  of  con- 
trast material  from  25-45  cc  is  quite  ade- 
quate for  the  final  filming. 

Eor  levels  above  this  to  fill  the  celiac  and 
superior  mesenteric  may  require  catheter 
sizes  of  greater  size  than  for  renals.  The 
drainoff  of  these  vessels  can  be  considerable. 

Attention  at  this  point  is  given  to  trans- 


Fig.  8.  Examples  of  “Flush”  aortography  for  renal  arteries. 


220 


Illinois  Medical  Journal 


lumbar  aortogiaphy,  a very  simple,  sate 
and  adequate  procedure.  Much  of  our 
work  is  upon  individuals  of  advanced  age 
and  compromised  circulation  of  the  lower 
extremities.  Catheter  placement  from  below 
can  be  difficult  or  impossible.  The  proced- 
ure should  be  painless  using  sufficient 
amounts  of  local  anesthesia.  The  needle  is 
inserted  from  the  back  on  the  left  side, 
7-10  cm  from  the  spinous  processes  and  the 
needle  is  below  the  twelfth  rib,  directed 
45°  cephalad  and  45%  to  the  midline.  An 
attempt  is  made  to  enter  the  aorta  at  the 
level  of  the  first  lumbar  and  twelfth  tho- 
racic vertebrae  utilizing  fluoroscopic  con- 
trol to  avoid  putting  the  needle  into  a 
branch  of  the  aorta.  When  the  flow  of 
blood  is  observed,  a small  test  dose  is  given 
slowly  under  fluoroscopic  observation.  Sidj- 
intimal  or  extravasation  then  is  held  to 
small  innocuous  amounts.  The  insertion  of 
an  additional  needle  at  a level  determined 
by  the  original  aortogram  can  then  be  en- 
tertained. 

A frequent  retpiest  is  visualization  of 
vascidar  circulation  of  the  posterior  cranial 
fossa.  This  area  is  supplied  by  the  vertebral 
basilar  artery  system.  Direct  puncture  or 
selective  catheterization  of  these  vessels  can 
in  the  first  instance  be  difficult  and  in  the 
second  rarely  necessary.  Even  momentary 
ischemia  of  structures  supplied  by  these 
vessels  is  undesirable.  Satisfactory  arterial 
filming  can  be  obtained  by  either  the  sim- 
ple technique  of  right  or  left  retrograde 
brachial  injections  or  selective  catheteriza- 
tion and  injection  of  either  subclavian  ar- 
tery, from  which  the  vertebral  arises.  In  the 
former  instance  45  cc  in  1.5  secs,  is  ade- 
quate. While  20-25  cc  in  2 sec.  in  the  lat- 
ter. 

Some  mention  should  be  made  about  the 
axillary  approach  to  the  aorta.  At  times  the 
tortuousity  of  the  inominate  artery  is  a 
hindrance.  In  patients  with  an  elevated 
arch,  the  angle  of  take-off  of  the  inominate 
from  the  arch,  makes  entry  into  the  ascend- 
ing aorta  difficult.®  It  is  better  approached 
from  the  left.  The  incidence  of  hematomas 
of  considerable  size  and  brachial  plexus  in- 
jury dictates  caution  in  considering  this 
approach. 

Inasmuch  as  the  anatomical  arrange- 
ments of  branches  of  the  aorta  are  the  same 
from  patient  to  patient,  it  makes  the  appli- 


cation of  preformed  catheter  techniques 
cpnte  satisfactory.  Our  set-up  has  catheters 
with  preformed  shapes  for  all  major  vessels 
arising  from  the  aorta.  These  may  be  end 
hole  catheters  but  additional  holes  may  be 
used.  Experience  has  dictated  that  end 
hold  catheters  only  be  employed  in  any 
major  vessel  to  the  cranium.  The  length 
of  the  catheter  makes  it  difficult  to  be  sure 
that  no  clots  have  formed  between  the  end 
and  last  hole  of  the  catheter. 

There  are  occasions  when  aortography 
is  desired  prior  to  selective  injections.  Care 
should  be  given  that  the  catheter  used  in 
these  situations  be  of  the  same  outer  di- 
mensions or  the  larger  of  the  two  be  used 
last,  ami  excessive  bleeding  at  the  puncture 
site  is  thus  avoided. 

As  a final  point,  stress  is  made  of  the 
necessity  to  have  multiple  and  variable 
types  and  sizes  of  catheters.  Having  equip- 
ment for  aortography  available  as  well  as 
selective  arterial  injections  at  each  exam- 
ination increases  one’s  versatility,  and  pro- 
duces better  and  more  complete  examina- 
tions. There  is  a tendency  to  terminate  the 
Ijrocedure  before  all  possible  information 
is  obtained.  As  long  as  the  patient  is  not 
being  harmed  in  any  way,  there  is  no  need 
to  bypass  additional  procedures.  An  ar- 
terial inincture  and  catheter  studies  are 
preferrably  a one  incident  occasion. 

Summary 

This  paper  attempts  to  present  a clinical 
approach  to  patients  being  considered  for 
arteriography.  Techniques  and  the  reasons 
for  these  are  presented  as  well  as  the  types 
of  ecpiipment.  Indications  and  contraindi- 
cations are  also  discussed. 

References 

1.  Seldinger,  S.  L,  “Catheter  Replacement  of 
Needle  Percutaneous  Arteriography:  New  Tech- 
nique,” Acta  Radiol.,  39:368-376,  1953. 

2.  Langsjoen,  H.,  Best  E.  B.,  "Studies  in  the  Pre- 
vention of  Complications  of  Angiography,” 
Amer.  J.  Roent.,  106:425-433. 

3.  Susman,  N..  Diboll,  W.,  “Fluid  Dynamics  in  the 
Tip  of  the  Multiholed  Angiographic  Catheter,” 
Radiol.,  92:843-848. 

4.  Judkins,  M.  P..  Radiologic  Clinics  of  North 
America,  "Percutaneous  Transfemoral  Selective 
Coronary  Arteriography,”  Vol,  VI,  No.  3,  467- 
492. 

5.  Bosniak,  M.,  “,\n  Analysis  of  Some  Anatomical 
Roentgenologic  Aspects  of  Brachiocephalic  Ves- 
sels.” Amer.  J.  Roent.,  91:1222-1231. 

6.  Pollard,  J.  J.,  Nebesar,  R.,  “Abdominal  angio- 
graphy,” Neic  Eng.  J.  Med.,  279:1035-1042,  1093- 
1100.  ' 


for  September  1970 


221 


indies 


indies 


Graph  1 

rrcndi  si/c 


7.0  H.o  9,02 


niillinictcrs 


Graph  2 


.09.1 

cemirnclcis 


.19010 


222 


Illinois  Medical  Journal 


-THE  VIEW 


BOX 


By  Leon  Love,  M.D. 

Director,  Department  of  Radiology,  Loyola  University  Hospital 
and  Chairman,  Department  of  Radiology,  Loyola  University 
Stritch  School  of  Medicine 


Figure  2 


This  is  a 32-year-old  male  who  entered  with 
a chief  complaint  of  gradually  increasing  mass 
in  the  left  side  of  the  abdomen  for  the  past 
three  months.  Lie  had  reported  previous  bouts 
of  fever  and  occasional  burning  on  urination. 
Physical  examination  revealed  a fairly  smooth, 
deep-seated  mass  in  the  left  upper  quadrant. 
No  other  abnormalities  were  noted.  The  urine 
revealed  5 - 7 WBC  per  hipower  field.  What’s 
your  diagnosis? 


1.  Hydronephrosis 

2.  Hypernephroma 

3.  Non-functioning  left  half  of  a 
horseshoe  kidney 

4.  Pararenal  pseudocyst 


(Answer  on  page  278) 


Figure  3 


for  September  1970 


22S 


Meteorologic  factors 

In  tlie  fallont 
Of  pollens  and  molds 


By  Herman  A.  Heise,  M.D.,  and  Eugenia  R.  Heise,  M.T./Colorado 


Abstract 

Ordinarily  the  concentration  ol  pollen 
and  mold  spores  is  determined  by  count- 
ing the  particles  which  settle  on  a sticky 
slide  over  a period  of  24  hours.  However, 
the  airplane  can  collect  as  many  jjarticles 
in  30  seconds  as  could  be  obtained  by  grav- 
ity method  in  24  hours.  These  “spot  checks” 
enabled  us  to  study  the  mechanism  of  fall- 
out, including  the  influence  of  bodies  of 
water,  wind  direction  and  velocity,  and  the 
effect  of  clouds,  smoke  and  ground  fog. 
In  the  final  analysis,  the  lapse  rate,  the 
changes  of  temperature  with  altitude,  is 
the  most  important  factor  in  fallout.  Our 
findings  indicate  that  we  can  prophesy  pol- 
len counts  as  accurately  as  tomorrow’s 
weather.  Yesterday’s  gravity  counts  may  be 
interesting:,  but  tomorrow’s  estimate  has 
practical  value. 

Ordinarily  the  published  and  broad- 
cast pollen  counts  are  obtained  Iry  count- 
ing the  particles  which  fall  upon  a glass 
slide  exposed  to  the  atmosphere  for  24 
hours.  The  number  of  pollen  grains  in  an 
area  of  one  square  centimeter  is  then  in- 
terpreted as  the  number  per  cubic  yard. 
This  method  has  some  shortcomings  which 
are  obvious  to  the  person  who  is  allergic 


(Commentary  accompanying  film  shown  at  1970 
annual  meeting  of  Illinois  State  Medical  Society. 


to  these  particles.  A 24  hour  exposure  may 
involve  a count  of  a mere  100  pollen  grains 
and  yet  the  hay  fever  victim  may  feel 
worse  than  when  the  count  is  five  times  as 
great.  This  may  be  explained  by  the  fact 
that  the  fallout  greatly  exceeded  his  thres- 
hold for  just  a few  hours  but  the  count 
was  very  low  the  rest  of  the  24  hour  period. 

When  the  airplane  is  used  for  collecting 
pollens,  we  are  able  to  collect  as  many 
solid  particles  in  30  seconds  as  would  be 
harvested  over  a 24  hour  period  by  the 
ordinary  gravity  method.  Thus,  we  can 
evaluate  the  inqDortance  of  diurnal  and 
nocturnal  variations;  the  effect  of  lapse 
rate;  wind  velocity  and  direction;  the  in- 
fluence ot  bodies  of  water,  the  importance 
of  clouds,  haze  layers  and  smoke;  and  par- 
ticularly, the  advantage  which  the  city  has 
over  the  surrounding  rural  areas  for  the 
hay  fever  and  asthmatic  patient. 

Although  knowledge  of  yesterday’s  pollen 
and  mold  count  is  interesting  enough  for 
broadcasting  in  newspapers,  and  by  radio 
and  television,  w'e  now  have  sufficient  in- 
formation to  prophesy  the  far  more  im- 
portant knowledge  of  what  may  be  ex- 
pected tomorrow;  and  estimates  concerning 
the  thnes  of  greatest  fallout  are  also  feasi- 
ble. The  study  also  convinces  us  that  in 
spite  of  the  well  worn  statement  that  we 
are  unable  to  do  anything  about  the 
weather,  we  nevertheless  have  some  control 


224 


Illinois  Medical  Journal 


over  the  factors  affecting  fallout. 

In  the  movie  we  see  the  solid  particles 
carried  aloft  by  the  unstable,  hot  surface 
air  on  a sunny  day.  Their  upward  journey 
is  halted  when  they  reach  the  haze  or 
cloud  layer.  This  cloud  layer  occurs  at  the 
altitude  where  the  temperature  and  dew 
point  meet. 

All  light  plane  pilots  know  that  rough 
unstable  air  is  often  encountered  when 
flying  low  over  a city  in  the  early  morning 
after  a cold  night.  This  condition  is  due 
to  the  warmth  of  the  city.  What  they  don’t 
see  is  that  the  air  over  the  city  particularly 
to  the  leeward  side  contains  about  one 
tenth  as  many  pollen  grains  as  are  found 
at  the  same  altitude  on  the  windward  side. 

Effect  of  Bodies  of  Water 

We  have  also  encountered  similar  turbu- 
lence when  flying  over  small  lakes,  in  the 
fall  of  the  year  when  the  water  is  warmer 
than  the  land.  The  warm  lake  has  the 
same  effect  on  the  distribution  of  pollens 
as  the  warm  city. 

The  effect  of  Lake  Michigan  on  pollen 
counts  near  the  western  shore  is  tremend- 
ous. On  a typical  hot  afternoon  in  the  fall, 
a narrow  band  of  cumulus  clouds  forms 
parallel  with  the  shoreline,  about  five  to 
fifty  miles  inland.  These  clouds  are  prac- 
tically stationary,  being  formed  where  the 
prevailing  west  wind  meets  the  cooler  air 
which  comes  off  the  lake.  This  cool  air  is 
replacing  the  rising  hot  air  over  the  land. 
The  cumulus  clouds  mark  the  barrier  for 
the  particles  which  have  been  carried  many 
miles  by  the  west  wind.  Pollen  counts  made 
by  flying  through  these  clouds  are  extreme- 
ly high.  At  these  times  the  hay  fever  vic- 
tim living  within  a few  miles  from  the 
lake  shore  is  relieved  of  most  of  his  symp- 
toms as  long  as  the  clean  east  wind  is  blow- 
ing. 

At  night  these  conditions  are  reversed. 
The  cumtdus  clouds  which  had  dammed 
back  the  solid  particles  now  disappear,  and 
when  the  earth  near  the  shoreline  has  lost 
enough  heat  by  radiation  to  make  it  cool- 
er than  the  water  of  the  lake,  the  now  stable 
air  over  the  land  dumps  its  pollens  and 
molds  along  the  shore  and  many  miles  in- 
land. The  hay  fever  sufferer  will  then,  al- 
most invariably,  blame  the  “dampness”  for 
his  symptoms.* 

We  have  demonstrable  evidence  of  un- 
stable air  which  occurs  on  a 10°F.  below 


zero  day  when  the  water  of  Lake  Michigan 
is  33°F.  Although  this  phenomenon  is  not 
directly  related  to  the  fallout  of  pollens, 
it  is  an  interesting  experience  to  actually 
see  the  ghost-like  masses  of  ice  crystals 
dancing  when  the  cold  west  wind  meets  the 
moisture  over  the  warmer  water. 

Thunderstorms  have  a profound  effect 
on  the  hay  fever  sufferer.  Although  the 
downpour  of  rain  may  clear  the  air,  the 
storm  itself  is  like  a huge  bonfire  causing 
tremendous  up-drafts,  with  gusty  winds 
racing  over  the  dry  land  to  feed  the  “fire”. 
These  winds  pick  up  the  pollen  grains 
which  plague  the  sensitive  persons. 

Comment 

Our  observations  would  be  of  little  value 
if  we  were  powerless  to  do  something  about 
them.  It  is  of  course  obvious  that  the  hay 
fever  sufferer  should  keep  his  windows 
closed  at  night,  and  avoid  traveling  fast  in 
too  well  ventilated  vehicles  particularly  in 
the  early  morning  hours.  He  should  also 
avoid  being  near  bodies  of  water  when  the 
water  is  warmer  than  the  land.  He  will  be 
better  off  in  the  warmer  city  than  the  cooler 
country;  better  when  the  night  air  is  un- 
stable, which  occurs  with  cloud  cover  or 
smoke.  However,  his  worst  enemy  is  ground 
fog,  since  the  moisture  often  embodies  the 
concentrated  supply  of  solid  particles  which 
had  accumulated  in  the  air  and  particularly 
in  the  clouds  during  the  day.  The  knowl- 
edge of  the  factors  influencing  fallout  makes 
it  possible  to  estimate  the  next  day’s  pollen 
count  with  the  same  accuracy  that  we  can 
prophesy  tomorrow’s  weather. 

The  concentration  of  ragweed  pollen, 
which  is  the  greatest  offender  in  fall  hay 
fever,  varies  according  to  a basic  pattern  in 
Milwaukee.  There  is  a slow  rise  in  the 
numbers  of  particles  beginning  in  early 
August,  reaching  its  peak  in  early  Septem- 
ber and  then  fading  away  until  the  end  of 
the  month.  This  basic  pattern  is  affected 
unfavorably  by  hot  strong  south  winds 
during  the  day  with  clear  sky  at  night,  rap- 
id cooling  of  the  ground  and  early  morning 

*The  mechanism  causing  the  dumping  of  pollen 
grains  and  mold  spores  near  the  shores  of  bodies 
of  water  was  discussed  at  an  hiternational  Seminar 
of  Paleoritologists  held  at  the  University  of  Ari- 
zona, At  that  time  we  were  told  that  paleontologists 
had  known  for  years  that  their  best  hunting 
grounds  for  fossilized  pollens  and  molds  had  been 
near  extinct  bodies  of  water.  The  explanation  for 
this  phenomenon  had  heretofore  eluded  them. 

(Continued  on  page  277) 


for  September  1970 


225 


NEW 

PHARMACEUTICAL 

SPECIALTIES 

I 

I by  Paul  deHaen 

For  detailed  information  regarding  indica- 
tions, dosage,  contraindications,  and  adverse 
reactions,  refer  to  the  manufacturer’s  package 
insert  or  brodiure. 

Single  Chemicals:  Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products:  Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products:  Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms:  Of  a previously  introduced 
product. 

A New  Drug  Application  has  been  granted  by 
the  U.S.  Food  and  Drug  Administration  for  the 
following  new  drugs. 

PERGONAL  Fertility  Agent 
Manufacturer:  Cutter 
KAFOCIN  PULVULES  Antibiotic 
Manufacturer:  Lilly 

Nonproprietary  Name:  Cephaloglycin  dihydrate 
HIPPUTOPE  Diagnostic-Contrast  Media 
Manufacturer:  Squibb 

Nonproprietary  Name:  Sodium  iodohippurate 
CLEOCIN  HCl  Antibiotic 
Manufacturer:  Upjohn 

Nonproprietary  Name:  Clindamycin  HCl  (USAN) 
Formerly:  Clinimycin  (USAN) 

NEW  SINGLE  CHEMICALS 

DALMANE  Sedatives  & Hypnotics-Nonbarbitu- 
rate  R 

Manufacturer:  Roche 

Nonproprietary  Name:  Flurazepam  HCl  (USAN) 
Indications:  Insomnia  characterized  by  difficulty 
in  falling  asleep,  frequent  nocturnal  awaken- 
ings and/or  early  morning  awakening. 
Contraindications:  Hypersensitivity  to  the  drug. 
In  pregnant  women  weigh  potential  benefits 
against  possible  hazard  to  mother  and  child. 
Not  recommended  for  persons  under  15. 
Dosage:  Usual  adult  dosage:  30  mg.  before  re- 
tiring 

Supplied:  Capsules,  15  and  30  mg. 

DOPAR  R 

Mcmufacturer:  Eaton 

LARODOPA  R 

Manufacturer:  Roche 

Nonproprietary  Name:  Levodopa  (USAN):  Mus- 
cle Relaxants-Parkinsonism  L-Dopa 
Indications:  Treatment  of  Parkinson’s  disease 
and  syndrome. 

Contraindications:  Evidence  of  uncompensated 
endocrine,  renal,  hepatic  cardiovascular  or 
pulmonary  disease,  narrow  angle  glaucoma, 
blood  dyscrasias  and  hypersensitivity  to  the 
drug.  Do  not  give  when  a sympathomimetic 
amine  is  contraindicated.  Avoid  concomitant 
administration  with  MAO  inhibitors  and  dis- 
continue inhibitors  two  weeks  prior  to  levo- 
dopa  therapy. 


Dosage:  Usual  inital  dose,  0.5  to  1.0  gm.  daily. 
Dose  must  be  carefully  titrated  for  individual 
patient. 

Supplied:  Capsules,  100,  250  and  500  mg.  (Eaton) 
Tablets  and  capsules,  250  and  500  mg.  (Roche) 

INAPSINE  ATARAXICS  R 

Manufacturer:  McNeil 

Nonproprietary  Name:  Droperidol  (USAN) 
Dehydrobenzoperidol 

Indications:  Preoperatively,  during  induction, 

and  maintenance  for  sedation  or  tranquiliza- 
tion.  Reduction  of  incidence  of  nausea  and 
vomiting.  Tranquilizing  supplement  in  general 
or  regional  anesthesia. 

Conti-aindications:  Hypersensitivity  to  the  drug 
Dosage:  Individualized 

Supplied:  Ampuls,  2 and  5 cc,  each  cc  contains 
2.5  mg. 

DUPLICATE  SINGLE  PRODUCTS 

BETAPEIN-VK  Penicillin  & Derivatives  R 
Manufacturer:  Bristol 

Nonproprietary  Name:  Penicillin  phenoxymethyl 
potassium  (USP) 

Indications:  Treatment  of  infections  due  to  sus- 
ceptible organisms. 

Contraindications:  Hypersensitivity  to  any  of  the 
penicillins. 

Dosage:  Usual  dosage  for  adults  and  children: 
125  t.i.d.  to  500  mg.  every  4 hrs. 

Usual  infant  dose:  50  mg./kg.  t.i.d. 

Supplied:  Solution,  125  and  250  mg./5  cc. 

EPINAL  Eye  Preparations  R 

Manufacturer:  Alcon 

Nonproprietary  Name:  Epinephrine  as  borate 
complex 

Indications:  Lowering  intraocular  pressure  in 

treatment  of  open-angle  glaucoma 
Contraindications:  Narrow-angle  glaucoma 
Dosage:  Usual  dosage:  One  drop  in  the  eye(s) 
once  or  twice  daily. 

Supplied:  Solution — 0.5%  and  1.0% 

GVS  VAGINAL  INSERTS 
Antiinfectives- Vaginal  R 

Manufacturer:  Savage 
Nonproprietary  Name:  Gentian  violet 
Indications:  Vaginitis  due  to  Candida  albicans 
(moniliasis) 

Contraindications:  Hypersensitivity  to  the  drug 
Dosage:  One  GVS  insert  daily,  preferably  before 
retiring,  for  12  days 
Supplied:  Vaginal  inserts 

STEMEX  Corticoids  R 

Manufacturer:  Syntex 

Nonproprietary  Name:  Paramethasone  acetate 
(ND) 

Indication:  Wide  variety  of  collagen,  allergic  and 
hematologic  diseases,  dermatologic  and  mis- 
cellaneous disorders. 

Contraindications:  Active  or  questionably  ar- 
rested tuberculosis,  psychoses  or  herpes  sim- 
plex of  the  eye,  except  in  acute  life-threaten- 
ing disorders.  Careful  clinical  judgment  is  re- 
quired in  presence  of  diabetes  mellitus,  active 
or  latent  peptic  ulcer,  acute  or  chronic  infec- 
tion. Pregnancy  particularly  during  the  first 
trimester. 

Dosage:  Individualized  according  to  severity  of 
disease  and  patient  response. 

Supplied:  Tablets,  2 mg. 

COMBINATION  PRODUCTS 

POLIOMYELITIS  VACCINE  Biological  R 

(Purified) 


226 


Illinois  Medical  Journal 


Composition:  Type  1 (Mahoney),  Type  2 

(M.E.F.  1)  and  Type  3 (Saukett) 
Manufacturer:  Connaught  Medical  Research  Lab- 
oratories, Toronto,  Canada 
Distributor:  Parke-Davis 
Indications:  Prevention  of  Poliomyelitis 
Contraindications:  Defer  immimization  in  pres- 
ence of  active  infection  or  acute  respiratory 
disease,  and  in  individuals  receiving  cortico- 
steroid or  other  immunodepressant  therapy. 
Hypersensitivity  to  streptomycin  or  neomycin. 
Dosage:  s.c.  or  i.m.,  three  1 cc  doses  at  intervals 
of  4 weeks  or  more  followed  by  a booster  of 
1 cc  6-12  months  after  the  third  dose.  1 cc 
recall  doses  should  be  given  every  2-3  years. 
Supplied:  Rubber-stoppered  vials,  10  cc 

EYE-STREAM  Eye  Preparations  o-t-c 

Manufacturer:  Alcon 
Composition:  Sodium  chloride 

Potassium  chloride 


Calcium  chloride 
Magnesium  chloride 
Sodium  citrate 
Sodium  acetate 

Indications:  Balanced  salt  eye  irrigation  solution 
Contraindications:  None  mentioned 
Supplied:  Solution  in  flexible  plastic  bottle  with 
one-hand  stream  dispenser. 

NU  ’LEVEN  PLUS  Enzymes-Digestive  o-t-c 
Manufacturer:  Lemmon 
Composition:  Pepsin  150  mg. 

Pancreatic  enzyme  concentrate  100  mg. 

Ox  bile  extract  100  mg. 

Cellulase  10  mg. 

Indications:  Digestive  aid 

Contraindications:  Biliary  tract  obstruction  or 
hypersensitivity  to  any  of  the  ingredients 
Dosage:  Usually  one  or  two  tablets  taken  with 
each  meal 
Supplied:  Tablets 


new  tranquilizer  developed  for  alcohol  treatment 


A new  tranquilizer  for  the  treatment  of 
alcohol  dependence,  Serentil^  (mesorida- 
zine),  has  been  developed  and  made  avail- 
able by  Sandoz  Pharmaceuticals,  Hanover, 
N.  J.  The  new  agent  offers  specific  advan- 
tages over  and  above  the  relief  of  the  an- 
xiety, tension  and  depression  that  may  pre- 
cipitate alcohol  abuse:  these  include  anti- 
emetic properties,  an  apparent  lack  of  ha- 
bituating characteristics  or  hepatic  toxicity, - 
and  the  availability  of  both  oral  and  par- 
enteral forms. 

In  preparation  for  release  of  Serentil, 
Sandoz  cooperated  with  the  Center  of  Al- 
cohol Studies,  Rutgers  University,  in  a 
massive  statistical  survey  of  alcohol  depend- 
ence and  physicians’  attitudes  toward  the 
problem,  including  a state-by-state  analy- 
sis. From  this  and  other  data  it  was  learned, 
for  example,  that  while  Indiana  ranks  13th 
in  the  total  number  of  alcoholics,  it  ranks 
20th  in  per  capita  number.  It  was  also 
noted  that  more  Indiana  physicians  (com- 
pared with  the  national  average)  report 


Rank 


Total  no.  alcoholics  Per  cap.  no.  Women 


California 

1st 

2nd 

more 

Florida 

12th 

23rd 

more 

Illinois 

3rd 

6th 

fewer 

Indiana 

13th 

20th 

more 

Massachusetts 

8th 

4th 

fewer 

Michigan 

6th 

11th 

fewer 

Missouri 

10th 

7th 

fewer 

New  Jersey 

7th 

10th 

more 

New  York 

2nd 

5th 

more 

Ohio 

5th 

13  th 

more 

Pennsylvania 

4th 

12  th 

fewer 

Texas 

9th 

34th 

more 

Wisconsin 

11th 

8th 

fewer 

that  at  least 

half 

their  problem 

drinkers 

are  women. 

As  part  of  its  program  to  introduce  Se- 
rentil, Sandoz  is  offering  interested  phy- 
sicians a series  of  recorded  panel  discus- 
sions with  leading  authorities  on  alcohol 
dependence  and  its  treatment.  Also  in 
preparation  by  Sandoz  is  an  Alcoholic  Di- 
rectory, a state-by-state  reference  of  treat- 
ment facilities  and  other  pertinent  data. 


National  association  formed 
For  drug  sales  representatives 

NASR,  Inc.,  a national  association  of  sales  representatives 
serving  the  drug  industry  has  been  incorporated  and  a 
membership  drive  initiated,  according  to  Richard  S.  Strom- 
men,  vice  president  of  the  new  association. 

A confidential,  national  placement  service  will  provide 
members  with  opportunity  for  advancement,  periodic  sal- 
ary and  fringe  benefit  surveys,  legal  services,  employer- 
employee  representation  and  group  travel  benefits. 

The  association  will  maintain  offices  at  300  N.  State 
Street,  Suite  5211,  Chicago  60610. 


for  September  1970 


227 


New  product 


Vacuum  curettage  unit  in  compact  form 


Berkeley  Tonometer  Co.'s  development 
of  the  new,  compact  VC  IV,  a tabletop 
version  of  its  popular  VC  II  Vacuum  Curet- 
tage Unit,  is  in  response  to  a growing 
preference  for  vacuum  curettage  in  thera- 
peutic abortion  procedures. 

The  basic  features  that  have  led  to  the 
increased  demand  for  the  VC  II  unit  have 
been  included  in  the  transition  to  the  com- 
pact model.  Although  not  intended  as  a 
substitute  for  the  floor-model  VC  II,  or  the 
VC  III  which  includes  Berkeley's  Vibrodil- 
ator™,  this  smaller  version  is  ideal  as  a 
supplementary  emergency  room  unit  in 
large  hospitals  or  wherever  the  additional 
features  of  the  larger  units  are  not  neces- 
sary. The  new  VC  IV  unit  is  priced  approxi- 
mately $200.00  less  than  the  VC  II,  and  is 
expected  to  make  expanded  use  of  vacuum 
curettage  procedures  possible. 

Housed  in  a rugged  steel  cabinet  and 
built  to  the  same  exacting  standards  set 
by  Berkeley  for  all  of  its  vacuum  curettage 
equipment,  the  VC  IV  delivers  high  vacuum 
with  high  volumetric  capacity.  It  too  util 
izes  Berkeley's  swivel  handle  and  Vacu- 
rettes^*^,  and  provides  primary  and  sec- 
ondary collection  bottles  to  ensure  ade- 
quate capacity  and  give  added  trap  pro- 
tection against  pump  carryovers. 

New  product  literature  is  available.  For 


information,  write  BERKELEY  TONOMETER 
CO.,  1215  Fourth  Street,  Berkeley,  Cali- 
fornia 9471  0. 


Accent  on  Living 

Handicapped  people  who  are  low  on  funds  can  get  a free  subscription  to  a 
valuable  self-help  idea  magazine  published  by  a non-profit  corporation  called 
ACCENT  On  Living.  "The  idea  of  ACCENT"  says  editor  Ray  Cheever,  himself  in 
a wheelchair,  "is  to  print  only  the  practical  kind  of  information  and  ideas  that 
can  actually  help  physically  handicapped  individuals  do  things  easier." 

"A  good  example  is  a specific  procedure  for  getting  from  your  wheelchair  into 
your  car  by  yourself  and  then  getting  your  wheelchair  into  the  car  easily."  The 
key  is  that  the  ideas  in  ACCENT  come  from  handicapped  people  who  really 
know  how  to  do  these  things  because  they  do  them  every  day  and  they  have 
become  successful." 

Special  income  tax  deductions  of  which  a physically  handicapped  person  can 
take  advantage  is  a feature  in  the  current  issue  and  is  an  example  of  the  spe- 
cialized helpful  information  edited  for  ACCENT. 

Anyone  can  get  informatian  by  writing  to:  The  Editor,  ACCENT  On  Living 
Magazine,  P.O.  Bax  726,  Bloomington,  Illinois  61701. 


228 


Illinois  Medical  Journal 


' 1 

r 

-A 

Surgical  Grand  Rounds  are  held  weekly  on  Saturday 
at  8:00  a.m.  in  the  Offield  Auditorium  at  Passavant  Me- 
morial Hospital.  Patient  presentations  from  Chicago  Wesley 
Memorial,  Passavant  Memorial  and  the  Veterans  Admin- 
istration Research  Hospitals  form  the  basis  of  the  discus- 
sions. This  case  report  was  part  of  the  Surgical  Grand 
Rounds  held  on  March  21,  1970. 


Neurogenic  tumor 

of  tlie 


mediastinum 


Edited  by  John  M.  Beal,  M.D. /Chicago 


Case  Report : 

Dr.  Maurice  Schulten:  A 28-year-old, 
white  female,  without  symptoms  was  ad- 
mitted to  Passavant  Memorial  Hospital  be- 
cause a routine  chest  X-ray  revealed  a 
mass  in  the  posterior  mediastinum.  She 
denied  weight  loss,  cough,  hemoptysis,  ex- 


posure to  tuberculosis  or  chest  pain.  She 
had  been  smoking  three-fourths  of  a pack 
of  cigarettes  every  day  for  eight  years. 

Past  history  was  not  relevant.  Review  of 
systems  was  negative.  Physical  examina- 
tion: blood  pressure,  120/80;  pulse,  88  and 


Fig.  1.  Chest  X-ray  demonstrates  mass  in  the  left  side  of  the 
mediastinum. 


230 


Illinois  Medical  Journal 


regular;  respirations,  18;  temperature,  98.9°. 
She  appeared  well-developed,  well-nour- 
ished, alert,  cooperative  and  without  dis- 
tress. Physical  examination  was  unremark- 
able. Significant  chest  findings  were  absent. 
Routine  laboratory  work  was  within  norm- 
al limits,  and  an  electrocardiogram  was  in- 
terpreted as  normal.  Skin  tests  for  coccidio- 
domycosis,  histoplasmosis  and  tuberculosis 
were  negative.  Pulmonary  function  studies 
were  within  normal  limits.  X-ray  examina- 
tion of  the  chest  was  obtained. 

Dr.  Abram  Cannon;  This  is  a beautiful 
demonstration  of  a mass  presenting  from 
the  left  side  of  the  mediastinum  (Figure 
1)  and  seen  well  posteriorly  on  the  lateral 
chest  film.  Spot  films  over  this  area  show 
that  this  mass  is  located  posteriorly,  and  the 
broadest  aspect  is  posterior  and  then  it 
presents  forward,  and  it  is  adjacent  to  the 
mediastinum  (Figures  2,  3).  The  oblique 
film  shows  evidence  of  erosion  of  the  un- 
dersurface of  the  third  rib.  I can’t  see  any 
erosion  of  the  pedicle.  This  typical  loca- 
tion of  the  bone  erosion  leads  one  to  think 
of  a benign  neurogenic  tumor  such  as  a 
neurofibroma.  The  roentgen  appearance  is 
that  of  erosion  from  pressure  and  not  in- 
vasion by  a malignant  process.  This  is 
rather  frequently  seen  with  neurofibroma 
and  neurilemmomas. 

No  calcium  is  present  in  the  mass,  but 
if  it  were,  its  presence  would  also  make 
you  think  of  a benign  lesion,  although  you 
can  get  calcium  in  a large  malignant  tumor 
that  has  undergone  necrosis  and  hemorr- 
hage and  then  subsequent  calcification,  but 
this  is  not  uncommon.  When  you  see  cal- 


Fig. 2.  Spot  film  suggests  erosion  of  undersurface  of 
the  third  rih. 


Fig.  3.  Lateral  view  demonstrates  the  posterior 
location  of  the  mass. 


cium,  you  should  think  of  a benign  lesion. 
Dr.  Schulten:  A left  thoracotomy  was  per- 
formed two  days  after  admission.  A mass 
was  found  in  the  left  paravertebral  gutter 
and  was  excised.  The  patient  recovered  well 
and  was  discharged  ten  days  after  opera- 
tion. 

Dr.  Arthur  Palmer:  The  specimen  was 
approximately  a 5 x 4 x 4 cm.  ovoid  mass, 
well  encapsulated  with  a glistening  gray 
capsule.  There  was  a central  area  of  soft- 
ening with  hemorrhage  seen  on  section. 
(Figure  4).  Microscopic  examination  (Fig- 
ure 5)  showed  spindle  shaped  cells  with 
ovoid  nuclei,  arranged  in  bundles.  Nuclear 
palisading  is  evident,  and  most  of  the  tum- 
or was  composed  of  the  densely  arranged 
Antoni  type  A tissue,  rather  than  the  more 
loosely  arranged  Antoni  type  B tissue  seen 
in  some  of  these  tumors.  These  gross  and 
microscopic  features  are  characteristic  of 
neurilemmoma. 

Dr.  Schulten:  The  classical  classification 
of  mediastinal  tumors  is  to  place  them  in 
the  anterior,  middle,  and  posterior  media- 
stinum. The  posterior  mediastinum  is  ac- 
tually the  two  paravertebral  gutters  and 
the  most  common  tumor  encountered  here 
is  of  neurogenic  derivation.  The  common- 
est neurogenic  tumor  is  the  neurilemmoma; 
the  next  most  frequent,  the  neurofibroma. 
Neurogenic  tumors  in  this  area  arise  from 
the  intercostal  nerves,  the  sympathetic 
nerves  and  ganglia.  Rarely,  neurogenic  tum- 
ors may  be  found  in  the  anterior  media- 
stinum. 

In  the  reported  series  of  mediastinal 
tumors,  the  most  commonly  reported  les- 
ions are  the  neurogenic  tumors  and  these 
comprise  approximately  25%  of  all  tumors. 
Teratomas  and  enterogenous  cysts  are  the 


for  September  1970 


231 


Fig.  4.  Cut  surface  of  tumor  demonstrated  en- 
capsulation and  central  area  of  softening. 


Other  two  frequent  types  of  mediastinal 
tumors. 

Specifically,  the  neurogenic  tumors  consist 
of  the  following  categories:  neurilemmoma, 
neurofibroma,  ganglioneuroma,  neuroblas- 
toma, sympatheticoblastoma,  pheochromo- 
cytoma,  paraganglioma  and  other  more 
rare  benign  and  malignant  neurogenic  tum- 
ors. The  relative  frequency  of  malignancy 
of  all  the  neurogenic  tumors  varies  from 
10-50%.  The  overall  incidence  of  the  va- 
rious types  of  tumors  is  conflicting  in  the 
various  reports  since  multiple  designations 
have  been  utilized  for  the  identical  tumors. 

By  and  large,  the  vast  majority  of  the 
neurogenic  tumors  are  asymptomatic.  The 
smaller  number  which  do  present  with 
clinical  symptoms  are  most  often  malignant. 
Occasionally,  however,  a benign  tumor, 
because  of  its  size  or  location,  especially 
with  extension  into  the  vertebral  foramen, 
may  produce  symptoms  related  to  the  cord 
or  nerve  root  compression. 

In  an  attempt  to  better  understand  these 
tumors  it  is  wise  to  separate  them  into  tum- 
ors in  the  adult  and  tumors  in  the  child. 
In  the  adult,  most  are  benign  tumors  and 
neurilemmomas,  and  the  remainder  are 
neurofibromas.  The  neurilemmoma  is  a 
tumor  compo.sed  of  .Schwann  cells  and  the 
neurofibromas  consist  of  all  the  elements 
of  the  nervous  tissue.  The  neurilemmoma  is 
an  encapsulated  tumor  and  is  very  likely 
to  undergo  degenerative  changes  within  its 
substance.  The  neurofibroma  is  not  encap- 
sulated and  degeneration  infrequently,  if 
ever,  occurs.  Rarely,  is  it  thought  that  either 
one  of  the  tumors  may  undergo  malignant 
degeneration.  In  children,  in  addition  to 
these  two  tumors,  neuroblastomas,  ganglio- 
neuromas and  ganglioneuroblastomas  are 


frequently  found.  The  neuroblastomas  are 
malignant,  and  the  overall  incidence  of  ma- 
lignancy in  neurogenic  tumors  in  children 
is  over  50%. 

Dr,  Thomas  Shields:  As  noted  by  Dr. 
Schulten,  most  of  the  neurogenic  tumors 
seen  in  adults  are  neurilemmomas.  The  vast 
majority  of  these  are  benign.  They  are 
asymptomatic  and  found  only  on  routine 
roentgen  examination  of  the  chest.  Occa- 
sionally, a dumb-bell  type  of  tumor  exists, 
but  their  presence  has  far  outweighed  their 
importance  because  of  the  fascinating  as- 
pect of  cord  compression.  When  this  occurs, 
the  usual  mode  of  approach  is  first  lami- 
nectomy and  removal  of  the  intraspinal 
portion,  and  then  a second  procedure  to 
remove  the  portion  within  the  thoracic 
cavity. 

Normally,  in  a young  adult  with  a sus- 
pected neurogenic  tumor,  a posteriolateral 
thoracotomy  incision  is  used  through  an 
interspace  without  sacrificing  a rib.  The 
pleura  is  incised  over  the  mass  and  the 
tumor  simply  is  enucleated.  In  this  par- 
ticular instance,  the  tumor’s  origin  from 
the  sympathetic  chain  was  tpiite  evident 
and  we  took  a portion  of  the  chain  along 
with  the  mass.  The  one  thing  to  remember 
is  that  these  tumors  are  supplied  by  the 
systemic  circulation  and  this  must  be  se- 
cured properly  or  there  will  be  postopera- 
tive bleeding.  We  have  found  the  use  of 
metal  clips  to  obtain  hemostasis  here  to 
be  most  advantageous. 


Fig.  5.  Microscopic  examination  demonstrates  spin- 
dle shaped  cells,  typical  of  neurilemmoma. 


Generally,  these  tumors  do  not  recur,  but 
we  had  one  instance  where  a relatively 
large  lesion,  approximately  the  size  of  a 
large  grapefruit,  recurred  three  years  later 
following  its  initial  removal.  At  this  time 


232. 


Illinois  Medical  Journal 


the  lesion  was  locally  nonresectable.  How- 
ever, this  was  a neurofibroma  rather  than 
a neurilemmoma. 

With  the  conflicting  reports  in  the  lit- 
erature, it  is  my  impression  that  the  recur- 
rence of  a benign  neurogenic  tumor  in  the 
posterior  mediastinum  is  relatively  unusual 
but  may  occur  in  von  Recklinghausen’s 
disease.  Generally  in  these  instances,  the 
tumor  is  of  the  neurofibromatous  type. 

One  of  the  troubling  features  when  one 
discusses  mediastinal  tumors  is  that  tumors 
are  relatively  rare  and  are  only  infrequently 
encountered  during  clinical  practice.  As  a 
result,  the  statistics  that  have  been  gathered 
have  been  accumulated  over  a long  period 
of  time  and  what  might  be  true  in  the 
past  really  is  not  true  for  the  present  time. 
About  66%  of  the  neurogenic  tumors  as 
reported  in  the  literature  are  benign  and 
33%  are  malignant,  but  this  includes  tum- 
ors in  both  children  and  adults.  If  one 
breaks  it  down  into  these  two  age  groups, 
one  finds  only  about  10-20%  are  malig- 
nant in  adults,  whereas  in  children,  about 
55%  are  malignant.  By  and  large  in  chil- 
dren, the  major  malignant  tumor  is  the 
neuroblastoma  or,  less  frequently,  the  ma- 
turing neuroblastoma,  which  may  run  a 
malignant  course. 

The  interesting  thing  in  children  is  that 
the  neuroblastomas  in  the  chest  are  fre- 
quently associated  with  neuroblastomas  in 
the  retroperitoneal  area.  In  56  children 
with  neurogenic  tumors  recorded  in  the 
Johns  Hopkins  series,  in  only  13  of  them 
was  the  tumor  isolated  within  the  thoracic 
cage.  In  this  series,  the  most  common  tho- 


racic neurogenic  tumor  was  the  ganglio- 
neuroma. The  other  major  lesion  was  the 
neuroblastoma  or  one  of  its  variants. 

One  interesting  feature  which  was  noted 
in  this  particular  group  of  children  was 
that,  regardless  of  the  histologic  maturity 
of  the  neuroblastoma,  the  tumor  could  pro- 
duce catecholamines  and  the  excretion 
product,  VMA  could  be  discovered  in  the 
urine.  In  these  children,  the  excessive  pro- 
duction of  the  catecholamine  was  associ- 
ated with  one  of  two  syndromes.  The  pa- 
tient may  present  with  diarrhea  and  ab- 
dominal distention,  or  may  present  with 
hypertension,  flushing  and  sweating.  Both 
syndromes  disappear  with  removal  of  the 
tumor. 

It  is  believed  that  neuroblastomas  should 
be  removed  if  possible  and  then  utilize  X- 
1 ay  therapy  to  the  area  postoperatively.  Oc- 
casionally, with  widespread  metastasis,  va- 
rious courses  of  chemotherapy  are  also 
used.  In  some  of  these  patients  the  meta- 
static lesions  will  mature  and  become  be- 
nign lesions.  This  is  a very  interesting  bi- 
ologic phenomenon  and  the  cause  of  it  is 
unknown. 

In  the  differential  diagnosis  of  neuro- 
genic tumors,  the  lesion  one  must  consider 
is  the  anterior  meningocele-meningo-mye- 
locele.  Most  often,  however,  there  is  a de- 
formity of  the  vertebral  body  that  is  quite 
obvious  and  this  should  tip  one  off  to  the 
diagnosis.  When  suspected,  the  diagnosis 
is  confirmed  by  myelography.  Lastly,  the 
occurrence  of  a chondrosarcoma  of  the  head 
of  the  rib  may  be  mentioned  in  the  dif- 
ferential diagnosis.  M 


"Mania"  Booklet  Available 


A comprehensive  clinical  booklet  of  cur- 
rent literature  on  manic-depressive  psy- 
chosis has  been  distributed  as  a profes- 
sional service  to  all  psychiatrists  in  the 
United  States  by  Rowell  Laboratories. 

Entitled  "Mania,"  the  publication  fea- 
tures 92  abstracts  of  the  most  significant 
clinical  reports  on  mania  and  its  control 
published  internationally  during  the  past 
five  years. 

Evaluation  and  selection  of  the  articles, 
and  the  abstracting  were  directed  and  per- 
formed by  the  staff  of  The  Excerpta  Medico 
Foundation. 


According  to  Rowell  President  T.  H. 
Rowell,  Jr.,  the  project  "is  a part  of  the 
professional  information  program  related 
to  company  introduction  of  Lithonate  (lith- 
ium carbonate)  in  the  treatment  of  manic- 
depressive  disease." 

Lithium  carbonate  was  approved  by 
FDA  in  April  for  treatment  of  the  manic 
phase  of  manic-depressive  illness. 

Copies  of  the  booklet  are  available  with- 
out charge  from  the  Professional  Service 
Department,  Rowell  Laboratories,  Baudette, 
Minn.,  56623. 


for  September  1970 


233 


The  private  non-afflliated. 
metropolitan  coramunity  hospital 


Its  responsibility 


To  postgraduate 

By  Lawrence  G.  Khedroo,  M.D.,  D.D.S. /Chicago 

The  inclusive  nature  of  post-graduate  medical  education 
ijivolves  and  is  affected  by  the  hospital  environment,  the 
administrative  organization,  the  medical  staff,  the  surround- 
ing community,  and  the  organized  content-structure  of  the 
resident-intern  program.  In  some  of  these  areas,  problems 
will  arise,  directly  or  indirectly  affecting  training  programs. 


The  community  hospital,  in  reference  to 
continued  development  and  growth,  may  be 
presented  by  a situation  in  which  there 
are  increasing  operating  costs,  a stable  but 
aging  medical  staff,  a deteriorating  neigh- 
borhood, difficulty  of  obtaining  the  serv- 
ices of  qualified  nursing  and  paramedical 
personnel,  a need  for  replacing  worn-out 
equipment,  and  an  inability  to  attract  new- 
er and  younger  practitioners  of  medicine. 

a.  The  steady  increase  in  operating  costs 
has  had  to  be  reflected  in  the  increasing 
cost  of  daily  medical  care.  The  private 
community  hospital,  depending  for  its 
fiscal  solvency  on  service  rendered  for 
fee,  must  depend  on  collections  of  mon- 
ies for  these  services  and  show  a profit 
of  sufficient  size  to  maintain  the  physi- 
cal plant,  replace  worn-out  equipment, 
and  continue  in-service  educational  pro- 
cedures. A major  difference  may  be  not- 
ed between  the  private  community  hos- 
pital and  a public  hospital  institution; 
the  latter  is  able  to  have  underwritten 
its  fiscal  debts  by  yearly  legislative  ac- 
tion. 

b.  Neighborhood  changes  will  possibly  re- 
flect the  influx  of  low-income  groups  of 
people,  which  will  not  attract  the  young 
medical  graduates  who  enter  private 


practice  each  year.  These  latter  will  most 
likely  situate  in  well-established  middle 
or  high  income  communities,  which,  in- 
cidentally, also  need  medical  car  e.  This 
could  be  alleviated,  in  part,  if  the  hos- 
pital would  initiate  a program  of  hiring 
young  physicians  to  man  certain  sections 
of  the  hospital,  such  as  the  out-patient 
clinics,  the  emergency  room,  the  in-serv- 
ice teaching  areas,  and/or  the  major  med- 
ical services.  Such  a program  would  give 
a starting  income  to  the  young  practition- 
er and  could  also  be  offered  to  older 
physicians  in  the  phase  of  retirement. 

c.  The  hospital  requires  additional  equip- 
ment from  year  to  year,  but  unlike  the 
equipment  bought  for  research  or  pilot 
projects,  private  institution  equipment 
has  to  justify  the  cost  and  be  able  to 
return  in  service,  and  above,  the  cost 
of  installation,  maintenance  and  opera- 
tion. This  limits  the  variation  and  so- 
phistication of  equipment  that  a com- 
munity hospital  can  buy  unless  it  can 
be  put  to  work  almost  immediately. 

d.  The  unsafe  neighborhoods  and  inef- 
ficient urban  transportation  renders  it 
difficult  to  keep  members  of  the  nursing 
profession  and  other  paramedical  per- 
sonnel who  are  attracted  to  more  stable, 
clean,  safe,  attractive  neighborhoods. 


234 


Illinois  Medical  Journal 


as  related 


medical 


education 


wherein,  incidentally,  the  salary  available 

may  not  be  the  prime  consideration. 

One  of  these  aforementioned  problems 
would  be  amenable  to  solution,  because 
concentrated  effort  could  be  applied  tow- 
ard improving  the  situation.  If  several  or 
all  of  these  problems  occur  in  a community 
hospital  at  the  same  time,  it  may  be  noted 
that  each  has  its  own  attrition  at  the  stable 
base  that  makes  the  hospital  a viable  con- 
cern. It  is  difficult  to  place  priorities  as  to 
which  problem  requires  the  earliest  solu- 
tion. These  situations  influence  a resident- 
intern  teaching  program  and  modify  pro- 
portionally the  kind  of  program  that  the 
director  of  medical  education  can  develop 
for  the  institution.  Needless  to  say,  in- 
adequate financial  income,  a deteriorating 
neighborhood,  a non-teaching  aged  medical 
staff,  inadequate  nursing  care,  and  modest 
equipment,  will  be  factors  which  take  away 
from  the  opportunity  to  develop  a first-class 
resident-intern  program. 

The  Administrative  Organization 

The  administration  is  in  a position  to  be 
the  continuous  thread  that  can  link  the 
various  programs  and  projects  together. 
As  the  center  point  of  all  information,  the 
decisions  made  in  the  education  program 
are  finalized  by  administration.  As  the  main 
originator  of  expenditures  for  funds,  the 
amount  of  money  available  for  medical 
education  is  finalized  by  administration. 
It  requires  sophistication  and  a definition 
of  goals  to  determine  the  amount  of  ef- 
fort expected  to  give  service  as  related  to 
that  expected  to  foster  medical  education. 
Too  often  the  service  aspects  of  a hospital 
institution,  instead  of  being  correlated  with 
teaching,  run  counter  current  to  the  teach- 
ing program. 


The  Medical  Staff 

Periodic  evaluation  of  delivery  to  the 
public  of  superior  medical  services  by  a 
hospital  institution  relates  to  the  staff  phy- 
sicians and  their  qualifications.  Good  med- 
ical care  can  be  a byproduct  of  continuing 
post-graduate  medical  education,  if  defini- 
tive assigned  teaching  responsibility  is  con- 
sidered a requisite  for  continued  staff  ap- 
pointment. In  performing  as  an  almost  to- 
tal service  organization,  the  medical  staff 
may  tend  to  forego  time  for  re-evaluation  of 
past  performance,  and  the  learning  of  new 
techniques.  As  a corporate  body,  seeking  to 
fill  the  need  and  accommodate  the  environ- 
ment, the  medical  staff  should  consider  in- 
vesting a certain  amount  of  effort,  in  refer- 
ence to  time,  study,  and  finances,  back  into 
improvement  of  the  application  of  medical 
care.  The  busy  medical  practitioner  and 
specialist,  working  long  hours  in  the  office 
and  in  the  hospital,  does  not  always  have 
opportunities  available  for  self-improve- 
ment, rest  and  reflection.  The  extra  time 
available  to  the  medical  practitioner  is 
often  reserved,  and  justly  so,  to  his  personal 
life  that  revolves  around  home,  family  and 
recreation.  Some  medical  practitioners  are 
much  too  busy  and  consistently  have  such 
irregular  working  hours  that  it  is  difficult 
to  schedule  something  as  prosaic  as  an  or- 
ganized review  course  at  a local  institution 
of  medical  learning  or  a special  course  by 
mail.  After  a busy  10-12  hour  day,  there 
is  not  much  energy  or  interest  remaining 
in  the  solitary  study  of  an  erudite  medical 
subject. 

Lawrence  G.  Khedroo,  M.D.,  D.D.S.,  is  clin- 
ical associate  professor  in  the  Department  of 
Anatomy  at  the  University  of  Illinois  Medical 
Center,  and  was  formerly  director  of  medical 
education  at  St.  Elizabeth  Hospital,  Chicago. 


for  September  1970 


235 


Sufficient  numbers  of  tafented  hard-work- 
ing physicians  in  general  practice,  after  ten 
or  fifteen  years  in  their  vocation,  find  that 
they  would  like  to  trim  back  their  medical 
responsibilities  and  enter  a specialty  of 
their  choosing  and  interest.  In  the  early 
part  of  the  twentieth  century  such  special- 
ization would  often  occur,  and  the  phy- 
sician would  then  acquire  the  reputation 
of  being  particularly  adept  at  taking  care 
of  certain  disease  processes,  and  on  this 
basis,  his  colleagues  would  refer  such  indi- 
cated patients  to  him.  Out  of  this  developed 
the  image  of  the  specialist,  which  permit- 
ted a more  efficient  delegation  of  time  spent 
in  the  practice  of  medicine.  Hard-working, 
capable,  and  sophisticated  physicians  in  gen- 
eral practice  have  found  the  way  to  self- 
improvement  and  specialization  blocked  be- 
cause of  the  financial  and  social  penalties 
necessary  to  withdraw  and  enter  a residency 
progTam.  These  men  have  found  that  there 
is  no  way  to  get  certified  in  a specialty  un- 
less the  necessary  years  are  taken  from  a 
practice.  It  would  be  a tremendous  stimulus 
to  these  men,  if  instead  of  being  enrolled 
in  full-time  residency  programs,  they  could 
enroll  in  part-time  programs:  e.g.,  a spe- 
cialty program  taking  four  years  to  complete 
could  be  permitted  to  be  completed  in 
twelve  years  at  one-third  the  involved  time. 
It  wonlcl  give  an  opportunity  to  these  phy- 
sicians to  be  in  the  mainstream  of  medicine, 
to  work  in  an  institution  with  university 
affiliation,  and  to  have  a goal  that  they 
can  look  forward  to  and  realize. 

Where  private  non-affiliated  community 
hospitals  are  located  within  short  distances 
from  each  other,  the  merging  of  some  of 
their  facilities  and  services  may  be  consid- 
ered: it  would  permit  the  use  of  specialized 
equipment;  it  would  increase  the  teaching 
medical  staff  faculty  and  permit  post-gnad- 
nate  medical  education  programs,  residen- 
cies, and  internships  to  qualify  for  approv- 
al; it  would  attract  specialists  in  certain 
categories,  for  example  an  endoainologist, 
a geneticist,  and/or  a biomedical  engineer; 
it  would  make  available  an  increased  and 
varied  volume  of  patients.  Specialization 
in  a certain  field  of  medical  service  by  one 
institution  would  make  this  particular  serv- 
ice available  to  the  other  institutions  in  the 
merger.  One  example  would  be  an  artifi- 
cial kidney  team  trained  in  hemodialysis 
or  a cardio-vascular  team  trained  in  open 
heart  surgery.  In  multihospital  affiliation. 


departmental  administrative  chairmen  need 
not  be  dismissed  or  changed.  For  each  de- 
finitive medical  service  and  educational 
program,  one  person  would  have  to  be  re- 
sponsible in  order  to  coordinate  and  fuse 
the  basic  objectives  of  each  hospital  insti- 
tution. Such  an  action  aimed  at  improving 
post-graduate  medical  education  can  serve 
to  upgrade  the  residency  and  intern  pro- 
grams. Such  a medical  staff  and  administra- 
tive association  requires  a spirit  of  give 
and  take,  and  should  not  be  entered  into 
without  careful,  detailed,  and  intuitive 
planning. 

The  Community 

The  people  living  in  the  area  which 
surrounds  a metropolitan  hospital,  through 
the  city  officials,  civic  leaders,  and  the  hos- 
pital administration  with  the  direct  sup- 
port of  the  lay  board,  should  be  enjoined 
to  realize  the  worth  of  such  an  institution 
to  the  community.  Provisions  should  be 
made  to  obviate  difficulties  which  may  arise 
—whatever  their  origin— in  order  to  main- 
tain friendly  relations  between  the  com- 
munity and  the  hospital  organization.  The 
hospital  should  not  present  too  authori- 
tarian a posture;  conversely,  the  community 
should  respect  organization  and  service 
ability. 

A method  of  assuring  the  hospital  of 
maintaining  and  rendering  service  to  the 
nearby  community  is  to  have  a hospital 
organization,  with  suitable  members  from 
its  various  divisions,  make  a personal  sur- 
vey of  the  community  and  meet  with  the 
leaders  of  the  community,  in  this  manner 
getting  first  hand  information.  It  is  con- 
ceivable that  information  given  by  govern- 
mental administrative  agencies  may  not  re- 
flect accurately  as  to  timing  what  the  needs 
are.  This  type  of  interchange  between  the 
hospital  and  community  leaders  will  serve 
to  indicate  and  maintain  the  sincerity  of 
the  medical  installation  in  its  effort  to  be 
of  primary  service  to  the  people  in  the 
surrounding  urban  area. 

The  Resident-Intern  Problem 

In  a non-affiliated,  moderate-size,  private 
community  hospital,  the  development  of 
a resident-intern  program  requires  a survey 
of  capabilities  and  a clear  evaluation  of 
attainable  goals.  To  develop  such  a pro- 
gram, the  hospital  lay  board  and  admin- 
istration should  be  sympathetic  toward  the 


236 


Illinois  Medical  Journal 


program,  and  be  willing  to  subtend  the 
costs  of  this  program.  A medical  staff  will- 
ing and  qualified  to  teach,  adequate  hous- 
ing and  recreation  facilities,  sufficient  and 
varied  clinical  material  as  to  out-patients 
and  in-patients,  and  qualified  laboratory, 
roentgenographic,  and  social  services  are 
also  necessary  components.  The  program 
must  initiate  from  the  medical  staff,  re- 
quire medical  staff  participation,  and  the 
teaching  responsibility  for  the  program 
must  be  directly  met  by  the  medical  staff. 
Often  a medical  staff  abrogates  its  respon- 
sibilities for  the  program  and  considers  that 
the  administration  or  para-medical  person- 
nel should  handle  day-to-day  affairs  of  a 
resident-intern  program.  When  this  occurs, 
the  service  aspects  of  the  program  tend  to 
take  precedence  over  the  teaching  aspects. 
Those  members  of  the  medical  staff  quali- 
fied to  teach  the  separate  categories  of  med- 
ical knowledge  should  be  enlisted  into  the 
program  and  be  given  time,  remuneration, 
authority,  and  a formal  appointment,  in 
order  to  upgrade  the  program  and  give  it 
the  necessary  prestige.  In  those  categories 
of  medical  knowledge  which  are  not  cov- 
ered by  the  training  of  the  medical  staff, 
special  speakers,  teachers,  and  demonstra- 
tions should  be  supplied  so  that  the  resi- 
dent and  intern  in  the  program  acquires 
the  basic  sciences  and  the  clinical  aspects 
of  his  training.  To  the  basic  sciences,  in 
addition  to  the  classic  divisions  of  anatomy, 
physiology,  pathology,  biochemistry,  pharm- 
acology, and  bacteriology,  should  be  added 
genetics,  biophysics,  bioengineering  and 
cytological  physiology.  In  the  clinical  sci- 
ences, the  sociological  aspects  should  be 
stressed  so  that  what  is  learned  can  be 
applied  to  the  locale  where  the  doctor  of 
the  future  wishes  to  settle  and  render  med- 
ical service.  It  is  best  to  have  a single  per- 
son in  charge  of  the  entire  program— a 
physician  with  a background  in  clinical 
medicine  and  teaching.  In  addition  to  or- 
ganizing such  a training  program  and  hav- 
ing it  qualified  and  approved,  the  resident- 
intern  program  requires  publicity  so  that 
medical  school  graduates,  national  and  in- 
ternational, may  be  cognizant  of  this  pro- 
gram. An  out-patient  clinic,  geared  to  serve 
the  needs  of  the  community,  affiliation  with 
a local  medical  school,  if  this  is  possible, 
and  the  infusion  of  the  teaching  staff  with 
outside  qualified  medical  personnel,  will 
help  to  delineate  the  direction  of  the  pro- 


gram. For  foreign  medical  graduates,  the 
social  services  can  do  much  to  orient  these 
visitor-students  and  to  make  them  feel  at 
home  in  new  surroundings.  As  these  new 
interns  and  residents  arrive  from  a foreign 
country,  the  hospital  and  its  personnel  will 
be  the  first  impression  that  the  foreign  visi- 
tor will  get  of  the  United  States,  and  the 
importance  of  this  and  the  need  for  a fa- 
vorable impression  cannot  be  overstressed. 
Residents  and  interns,  under  supervision 
and  with  permission,  should  have  access  to 
all  private  patients  so  that  good  patient 
evaluation  work-ups  can  be  performed  in 
order  that  the  clinical  material  is  available 
for  teaching  jiurposes.  It  will  be  found  that 
the  average  patient  is  well  enough  informed 
to  recognize  that  examination  by  several 
doctors,  in  an  effort  to  come  to  a correct 
diagnosis,  is  also  an  example  of  increased 
service  and  comes  very  close  to  being  ideal 
medical  care. 

The  real  and  projected  advantages  of  a 
post-graduate  training  program  carry  re- 
sponsibility and  repeated  evaluation.  With 
the  stimulation  of  teaching  and  learning, 
there  can  be  a continual  improvement  and 
upgrading  of  patient  diagnosis  and  treat- 
ment. Significantly,  it  might  be  considered 
that  a hospital  organization  which  is  quali- 
fied to  teach,  will  very  seldom  have  the 
quality  of  its  service  questioned;  whereby, 
a hospital  organization  that  does  not  have 
a teaching  progiam,  may  be  subject  to  re- 
peated evaluation  of  the  type  of  service 
that  it  renders.  The  corollary:  if  you  are 
good  enough  to  teach,  you  are  good  enough 
to  give  service. 

The  private,  small,  metropolitan  hospital 
which  has  acquired  an  improved  program 
in  a residency  and/or  internship  must  com- 
pete with  larger  institutions  to  fill  its  quota. 
As  it  often  does  not  have  a choice,  there 
is  a tendency  for  the  education  and  cre- 
dentials committees  to  approve  all  appli- 
cations until  the  quota  is  filled.  Under 
these  circumstances,  it  is  still  desirable  to 
choose  an  appointee  who  has  the  desire  to 
learn  and  after  fulfilling  the  requirements, 
to  stimulate  the  post-graduate  future  med- 
ical practitioner  to  embark  on  a personal 
continuing  education  program.  Not  every 
program,  how'ever  well  qualified,  has  all 
the  teaching  and  teaching  material  neces- 
sary. The  post-graduate  trainee  must  be  ad- 
vised to  learn  his  particular  course  of  study 
from  a broad  national  view,  so  that  he  may 


for  September  1970 


237 


take  his  certifying  examination  anywhere 
with  confidence.  The  corollary:  to  develop 
in  the  future  practitioner  the  desire  to  be 
a continuous  student  of  medicine  is  a prime 
goal  of  a medical  training  program. 

Many  of  the  resident-intern  programs 
advertise  the  non-learning  advantages,  such 
as  location,  recreation,  living  facilities,  sal- 
aries, and  personal  contacts.  These  latter 
have  importance,  to  be  sure,  but  certainly 
should  not  be  the  prime  consideration  of 
a training  program.  It  is  conceivable  that 
some  of  the  best  training  programs  are  not 
in  a plush  suburban  hospital  setting,  but 
more  likely  in  a small  community  hospital, 
in  a small  town  with  an  agrarian  popula- 
tion; or  perhaps  in  a teeming  city,  where 
overcrowding  and  the  effects  of  close  city- 
dwelling markedly  affect  the  type  of  disease 
seen.  There  is  also  the  philosophical  aspect 
of  the  resident-intern  program,  as  to  what 
constitutes  learning  and  what  constitutes 
service.  Part  of  learning  in  a teaching  pro- 
gram is  to  render  service,  since  the  future 
practitioner,  in  the  main,  will  devote  a 
large  part  of  his  time  to  service  to  the  com- 
munity and  will  have  to  schedule  his  time 
for  personal  enjoyment  and  recreation  as 
well  as  learning.  These  philosophical  as- 
pects of  the  resident-intern  training  pro- 
gram should  be  stressed  to  the  applicant  in 
the  program.  This  will  help  maintain  a 
high  standard  of  applicants,  although  it  may 
be  difficult  to  fulfill  the  quota  in  competi- 
tion to  other  more  recreationally  attractive 
programs.  The  corollary:  the  education 
committee  should  organize  a set  of  stand- 
ards and  then  maintain  them  with  firmness 
and  determination.  It  may  be  pointed  out 
that  service  is  a type  of  learning:  learning 
to  take  responsibility,  to  be  unselfish,  and 
to  be  someone  to  somebody  in  a social- 
conscious world. 

The  resident-intern  program  requires 
that  it  maintain  a reasonable  high  level  of 
educational  quality.  In  reference  to  the  re- 
cent trends  in  medical  education,  of  flexi- 
bility of  the  content  of  the  teaching  pro- 
gram, and  in  the  absence  of  definitive  med- 
ical school  affiliation,  provision  can  be  made 
for  residents  and  interns  to  partake  of  re- 
view courses  and  research  projects  in  the 
neighboring  medical  schools  and  university 
hospitals.  In  this  manner,  sophisticated 
trends  in  the  newer  sciences  of  genetics, 
cyto-biology,  biomedical  engineering  and 
biophysics  may  be  made  part  of  the  regular 


training  program.  Residents  and  interns, 
accustomed  to  teaching  and  service  in  the 
clinical  aspects  of  medicine,  will  have  an 
opportunity  to  return  to  the  classroom- 
laboratory  in  order  to  gain  the  atmosphere 
of  learning  and  reflection  which  can  be 
more  conveniently  experienced  in  the  med- 
ical schools  and  the  teaching  university 
hospitals.  In  this  manner,  the  house  staff 
will  have  an  opportunity  to  leave  the 
“home”  hospital  for  a half-day  or  day  for 
another  medical  installation.  This  type  of 
program  can  be  arranged  with  the  local 
medical  school  and  university  hospitals, 
and  whether  it  is  part  of  the  resident-intern 
program  in  the  community  hospital  or 
whether  it  is  approved,  it  will  serve  as  a 
stimulus  and  enable  the  community  hos- 
pital to  fill  in  the  possible  gaps  in  its  edu- 
cation program.  The  philosophical  basis 
for  this  rests  with  the  possibility  that  no 
one  institution  completely  covers  the  field 
for  which  it  is  approved  in  a special  resi- 
dency or  intern  program,  and  its  teaching 
course  can  be  enhanced  by  such  outside 
programs.  These  do  not  necessarily  have 
to  be  definitive  or  formal  affiliations,  but 
simple  agreements  between  institutions  in 
order  to  permit  a resident  and  intern  to 
feel  that  he  has  a choice  of  changing  some 
of  the  content  of  the  program  to  which  he 
has  been  primarily  assigned.  Examples  of 
these  are  a pediatric  residency  program  in 
which  the  resident  has  an  opportunity  to 
learn  additional  information  concerning 
congenital  defects  and  the  relationship  to 
cytogenetics;  the  orthopedic  resident  who 
may  acquire  an  interest  in  bone  tumor 
pathology  and  obtain  such  information  at 
the  nearby  medical  school  department  of 
pathology;  the  rotating  internship  program 
which  may  offer  the  intern  additional  train- 
ing in  hematology  or  bacteriology.  The 
community  hospital  can  arrange  for  lec- 
tures, demonstrations,  or  grand  rounds  to 
be  held  at  stated  intervals,  with  or  without 
monetary  remuneration,  as  the  situation 
may  dictate,  and  for  teachers  of  professorial 
rank  to  come  to  the  community  hospital 
and  be  occasional  part-time  teachers  in  the 
residency-intern  program. 

Philosophically,  in  reference  to  the  resi- 
dent-intern program,  it  should  be  decided 
whether  the  program  should  be  tailored  to 
the  residents  and  interns  that  come  into 
the  program,  or  whether  the  program 
(Continued  on  page  277) 


238 


Illinois  Medical  Journal 


statute 
Of  limitations 
in 

Malpractice 

Lawsuits 

By  Frank  M.  Pfeifer,  Counsel,  ISMS 

The  Supreme  Court  of  Illinois  recently 
handed  down  a decision  in  the  case  of 
Lipsey  vs.  Michael  Reese  Hospital  and 
Dr.  Gerald  Menaker,  in  which  the  Statutes 
of  Limitations  in  malpractice  cases  is  ex- 
tended and,  in  some  instances,  nullified. 
The  law  in  Illinois,  until  this  decision,  was 
that  an  action  of  malpractice  had  to  be 
commenced  within  two  years  after  the  al- 
leged negligent  act  took  place  and  if  the 
lawsuit  was  not  filed  within  this  time,  it 
was  barred. 

Mrs.  Lipsey,  under  the  treatment  of  Dr. 
Menaker  in  Michael  Reese  Hospital,  had  a 
lump  removed  from  under  her  arm  and 
a biopsy  was  performed  by  the  pathology 
department  of  the  Hospital  with  the  report 
that  the  removed  tumor  was  not  malig- 
nant. Two  and  one-half  years  later  Mrs. 
Lipsey  again  contacted  Dr.  Menaker  with 
the  same  complaint,  at  which  time  he  re- 
moved enlarged  lymph  nodes  from  under 
the  plaintiff’s  arm  and  a lump  from  her 
left  breast.  The  pathology  report  from  the 
hospital  disclosed  a malignant  condition  in 
both  the  lymph  nodes  and  the  breast. 

Mrs.  Lipsey  then  went  to  a hospital  in 
New  York  where  radical  surgery  was  per- 
formed for  the  removal  of  her  left  breast, 
shoulder  and  arm.  The  New  York  Hospital 
obtained  a frozen  section  of  the  lump  re- 
moved when  she  was  first  in  Michael  Reese 
Hospital  and  the  pathology  department  of 
the  New  York  Hospital  pronounced  it  ma- 
lignant. 

Mrs.  Lipsey  then  brought  suit,  which  was 


then  more  than  two  years  after  the  removal 
of  the  lump  and  the  incorrect  diagnosis 
in  the  Chicago  Hospital,  but,  was  within 
two  years  after  the  discovery  of  the  incor- 
rect diagnosis  had  been  made. 

Both  the  physician  and  the  hospital 
moved  to  strike  the  complaint  as  being 
barred  by  the  two  year  Statute  of  Limita- 
tion, but  the  Supreme  Court,  in  reversing 
all  prior  Illinois  law  on  this  subject,  held 
that  it  would  be  unrealistic  and  unfair  to 
bar  the  cause  of  action  of  the  injured  party 
before  the  negligence  had  been  discovered. 
The  Court  then  specifically  held  that  the 
lawsuit  could  be  filed  any  time  within  two 
years  after  the  act  of  negligence  became 
known.  This  so-called  “discovery  rule”  has 
been  upheld  in  other  jurisdictions  but  this 
is  the  first  time  that  it  has  been  applied  in 
malpractice  cases  in  Illinois. 

In  all  cases  before  our  Supreme  Court, 
either  side  may  ask  for  a rehearing  after  a 
case  has  been  decided.  The  physician  and 
hospital  were  given  until  August  10  to 
file  a petition  for  such  a rehearing.  In 
the  opinion  of  the  writer  of  this  article, 
there  is  very  little  chance  that  such  a hear- 
ing will  be  granted  and,  if  this  is  correct, 
the  decision  will  become  final. 

If  this  decision  is  not  changed  on  re- 
hearing it  will  mean  that  there  is  no  longer 
any  limitation  insofar  as  malpractice  is 
concerned,  as  lawsuits  may  be  brought  at 
any  time  within  two  years,  after  the  al- 
leged act  of  negligence  has  been  discovered 
by  the  patient.  The  specific  holding  of  the 
Illinois  Supreme  Court  is  that,  in  a medical 
malpractice  case,  the  cause  of  action  ac- 
crues at  the  time  of  the  discovery  of  the 
negligence  and  not  at  the  time  of  its  oc- 
currence. 

In  1965,  the  Illinois  Legislature  added  a 
new  section  to  the  Limitations  Act,  which 
provided  that  if  in  the  course  of  any  med- 
ical or  surgical  treatment  or  operation,  any 
foreign  substance  was  permitted  to  remain 
within  the  body  which  caused  harm,  the 
Statute  of  Limitations  would  not  begin  to 
run  until  the  negligence  was  discovered, 
but  the  Act  further  provided  that  no  action 
could  be  commenced  within  ten  years  after 
the  negligent  act.  While  this  Statute  is  not 
an  issue  in  this  case  the  courts  will,  in  the 
future,  prabably  adopt  the  discovery  rule 
in  this,  categorically,  and  eliminate  the  ten 
year  limitation  provision. 


tor  September  1970 


239 


The  Medical  Examining  Committee  of  the  Department 
of  Registration  and  Education  of  the  State  of  Illinois  has 
recently  been  the  target  of  rather  acrimonious  criticism 
from  members  of  the  Illinois  State  Medical  Society^.  It  is 
alleged,  among  other  things,  that  the  Coinmittee  is  pre- 
venting “highly  qualified”  physicians  from  entering  prac- 
tice in  Illinois  because  a clinical  competence  examination 
is  required.  Apparently  the  Committee  is  not  working  hard 
enough,  and  is  processing  examinations  on  a quarterly 
basis  instead  of  continuously.  It  is  alleged,  much  to  the 
surprise  of  the  Committee,  that  other  states  are  making 
coritinuous  examinations  available.  The  authority  for  this 
opinion  is  not  quoted.  There  have  been  other  criticisms. 
Most  of  these  are  the  result  of  misunderstanding,  misin- 
formation, and  lack  of  comprehension  of  the  problems  of 
licensure.  KHS. 


Medical 


Let’s  reciprocate 


By  George  H.  Burke,  M.D./Rock  Island 


I’here  is  an  urgent  need  to  change  the 
procedure  for  issuing  medical  licenses  by 
reciprocity  in  Illinois. 

Members  of  the  Rock  Island  County  Med- 
ical Society  have  learned  of  this  need 
through  their  efforts  to  recruit  badly  need- 
ed physicians,  and  the  frustrations  they 
have  felt  on  numerous  occasions  when  they 
have  found  that  lack  of  reciprocal  licensing 
was  just  too  big  a stumbling  block  for  the 
fully  qualified  doctors  they  were  trying  to 
recruit. 

I would  not  have  my  present  associate 
if  he  had  been  required  to  take  an  exam- 
ination for  Illinois  licensure.  As  a former 
associate  professor,  he  was  one  of  the  for- 
tunate physicians  licensed  by  eminence  in 
1969.  Originally  licensed  in  New  York,  in 
1944,  and  subsequently  licensed  in  New 
Jersey,  and  West  Virginia,  he  came  to  Rock 
Island  County  highly  qualified;  yet  he  has 
told  me  flatly  that  he  would  not  have  come 
if  he  had  been  required  to  take  an  exam- 
ination. 

My  own  experience  is  not  unique.  Rock 
Island  County  has  lost  doctors  because  re- 


ciprocal licensing  is  not  a reality,  and  it 
is  quite  apparent  that  many  other  county 
societies  have  suffered  the  same  frustrations. 
Widespread  discontent  with  the  present 
system  was  voiced  by  many  delegations  at 
the  1970  ISMS  convention.  The  depth  of 
their  sentiments  became  obvious  when  the 
House  of  Delegates  rejected  a negative  Ref- 
erence Committee  report  and  adopted  a 
Rock  Island  County  resolution  aimed  at 
speeding  up  licensure  by  reciprocity. 

It  is  interesting  to  note  that,  according 
to  AMA  statistics  (JAMA,  June  15,  1970), 
there  are  34  states  which  will  endorse  li- 
censes granted  by  Illinois,  yet  Illinois  will 
accept  those  of  no  other  state. 

(Continued  on  page  269) 

George  H.  Burke,  M.D.,  is  chief  of  radiology 
at  St.  Anthony’s  Hospital  in  Rock  Island.  He 
received  his  M.D.  from  the  University  of  Michi- 
gan Medical  School.  A Diplomate  of  the 
American  Board  of  Radiology  and  former  presi- 
dent of  the  medical  staff  at  St.  Anthony’s.  Dr. 
Burke  is  also  the  chairman  of  the  Committee 
on  Legislation  and  Public  Affairs  in  Rock 
Island  and  on  the  Board  of  Directors  of  the 
lowa-Illinois  Central  District  Medical  Associa- 
tion. 


240 


Illinois  Medical  lournal 


Licensure 


Let’s  not  reciprocate 

Licensure  Problems  in  Illinois 

By  Kenneth  H.  Schnepp,  M.D.,  and  William  G.  McCarthy,  M.D. /Springfield 


Without  going  into  the  history  of  medical 
licensure  in  Illinois,  it  may  be  pointed  out 
that  the  present  Act  was  adopted  July  1, 
1923.  It  has  been  amended  in  minor  mat- 
ters a number  of  times  but  in  its  basic  prin- 
ciples the  Act  is  essentially  unchanged  since 
1923. 

The  Act  provides  for  the  issuing  of  li- 


Kenneth  H.  Schnepp,  M.D., 

(not  shown),  is  a Springfield 
surgeon.  He  received  his  M.D. 
degree  from  the  University  of 
Illinois  College  of  Medicine. 

A Fellow  of  the  American 
College  of  Surgeons  and  the 
American  Medical  Writer’s 
Association,  Dr.  Schnepp  is  founder  of  the 
Bulletin  of  the  Sangamon  County  Medical  So- 
ciety and  the  Springfield  Medical  Library  As- 
sociation. He  has  also  served  as  a member  and 
chairman  of  the  Medical  Examining  Commit- 
tee, State  of  Illinois,  and  as  a member  of  the 
Examining  Institute,  Federation  of  State  Medi- 
cal Boards  of  the  United  States.  William  G. 
McCarthy,  M.D.,  (right)  is  a general  surgeon. 
He  received  his  M.D.  from  Loyola.  A Fellow 
of  the  American  College  of  Surgeons  and  a 
Diplomate  of  the  American  Board  of  Surgeons, 
Dr.  McCarthy  is  secretary  of  the  Illinois  Medi- 
cal Examining  Board. 


censes  to  practice  medicine  and  surgery  in 
all  its  branches.  In  addition,  it  specifically 
creates  licensure  for  the  practice  of  any 
system  or  method  of  treating  human  ail- 
ments without  the  use  of  drugs  or  medi- 
cines and  without  operative  surgery.  It 
should  be  pointed  out  that  the  Medical 
Practice  Act  has  no  jurisdiction  over  relat- 
ed health  fields  such  as  podiatry,  dentistry, 
veterinary  medicine,  nursing,  optometry 
pharmacy,  physical  therapy  or  psychology. 

Two  other  forms  of  license  have  been 
added  to  the  Act  since  World  War  II.  The 
first  is  a temporary  license,  which  is  the 
practice  of  medicine  in  all  its  branches. 
It  is  limited  to  a specific  time  and  hos- 
pital, and  is  intended  to  encourage  grad- 
uates of  accredited  medical  schools  to  come 
to  Illinois  for  residency  training.  These 
are  readily  issued  to  approved  hospitals  and 
are  controlled  and  retained  by  the  respon- 
sible hospital. 

The  second  form  of  licensure  to  be  added 
was  the  State  Hospital  Permit.  This  is 
granted  to  employees  of  the  Departments 
of  Mental  Health,  Public  Health,  Child  and 
Family  Services,  and  their  affiliated  train- 


for  September  1970 


241 


ing  facilities.  The  holder  of  such  a permit  is 
restricted  to  the  institution  to  which  he 
has  been  assigned,  and  theoretically  is  un- 
der the  constant  scrutiny  of  a fully  licensed 
individual.  The  Act  encourages  such  a per- 
mit holder  to  seek  full  licensure  at  the  ear- 
liest opportunity  and  requires  evidence  of 
continuing  medical  education.  Since  1966, 
holders  of  such  permits  have  been  permit- 
ted but  two  renewals,  which  in  effect,  gives 
six  years  in  which  to  obtain  full  licensure. 

Throughout  the  entire  Act  the  term, 
“in  the  judgment  of  the  Department”  is 
used.  Previous  to  1945,  the  Director  of  the 
Department  of  Registration  and  Education 
was  a virtual  dictator.  He  could,  and  fre- 
quently did,  order  licenses  issued  by  re- 
ciprocity or  examination  almost  at  will, 
without  regard  to  the  opinion  of  the  Med- 
ical Examining  Committee.  As  the  result 
of  a scandal  in  which  it  was  alleged  that 
the  then  Director  was  in  fact  profiting  fi- 
nancially by  issuing  licenses  to  the  right 
people,  the  Act  was  amended  in  1945,  to 
state  that  none  of  the  functions,  powers, 
and  duties  enumerated  in  the  Act  could  be 
exercised  by  the  Director,  except  upon  the 
action  of  and  report  in  writing  of  the 
Medical  Examining  Committee.  This  has 
probably  been  the  most  important  change 
in  the  Act  since  1923. 

The  Civil  Administrative  Code 

Up  to  this  point,  the  Medical  Practice 
Act  has  been  referred  to.  Eew  people, 
indeed,  realize  that  another  Act  is  im- 
portant in  the  licensure  procedures  of  the 
state.  This  is  the  Civil  Administrative  Code, 
adopted  tinder  Governor  Lowden  in  1917. 
This  Act  created  the  Department  of  Regis- 
tration and  Education,  and  among  other 
things,  the  Medical  Examining  Committee. 
It  provided  for  five  licensed  doctors  of 
meclicine  to  which  could  be  added  by  the 
Director,  when  necessary,  other  practition- 
ers in  other  fields  to  conduct  examinations 
peculiar  to  their  schools.  Since  then,  a doc- 
tor of  osteopathy  and  doctor  of  chiropractic 
have  been  appointed  as  additional  examin- 
ers. 

It  is  the  duty  of  this  Committee,  among 
other  things,  to  conduct  the  examinations 
for  licensure  four  times  each  year,  assemble 
the  grades,  and  recommend  in  writing  to 
the  Director,  the  granting  of  licenses  in 
the  various  categories.  The  Committee  also 
is  the  hearing  body  for  the  purpose  of  sus- 


pending or  revoking  licenses,  for  cause, 
and  for  the  purpose  of  reinstating  licenses. 

It  must  be  emphasized  that  the  Medical 
Examining  Committee  has  no  adminis- 
trative function.  The  Department  of  Reg- 
istration and  Education  (meaning  the  di- 
rector) makes  all  administrative  decisions 
in  the  enforcement  of  the  Act  with  the 
exception  of  examinations  and  issuing  li- 
censes. All  disciplinary  actions  must  orig- 
inate outside  the  Medical  Examining  Com- 
mittee. In  passing,  it  might  be  mentioned 
that  membership  on  this  Committee  car- 
ries no  compensation. 

Activities  During  1968  and  1969 

With  this  brief  review,  it  might  be  of  in- 
terest to  scrutinize  the  activities  of  the 
Medical  Examining  Committee  during  the 
past  two  years.  During  this  two-year-period 
the  Committee  met  23  times.  Eight  of  these 
meetings  were  to  conduct  examinations, 
but  other  business  also  was  transacted.  In 
addition  to  these  full  meetings,  partial  or 
committee  meetings  were  held  on  six  oc- 
casions for  specific  purposes.  In  addition 
to  these,  individual  interviews  for  National 
Board  and  ELEX  interviews  were  held  in 
Harrisburg,  Springfield,  Galesburg,  Pon- 
tiac, Dolton  and  Chicago.  The  total  number 
of  these  interviews  is  unknown,  but  29 
were  held  in  1969,  in  Springfield  alone. 

During  the  two  year  period,  570  licenses 
were  issued  by  endorsement  of  a National 
Board  Certificate,  55  licenses  were  issued 
by  “emminence,”  11  were  issued  by  endorse- 
ment of  ELEX  examinations  taken  in  an- 
other state,  and  there  were  34  restorations 
of  licenses  that  had  lapsed.  This  was  a 
total  of  670  licenses  issued  by  endorsement 
and  interview. 

Also  during  this  two  year  period,  in  eight 
examinations,  342  applicants  were  granted 
licenses  by  full  examination.  This  group 
was  almost  entirely  made  up  of  foreign 
graduates.  (When  it  is  necessary  to  admin- 
ister a full  examination  to  an  American 
graduate  at  the  present  time,  it  usually 
means  he  previously  failed  the  National 
Board). 

The  remaining  group  of  licentiates  in- 
cludes the  so-called  “reciprocity”  applicant. 
These  are  the  applicants,  licensed  in  an- 
other state,  that  are  given  a clinical  exami- 
nation or  test  of  clinical  competence  before 
reciprocity  is  granted.  No  one  is  quite  sure 
when  this  practice  began  but  it  has,  at  least. 


242 


Illinois  Medical  Joutnal 


been  the  custom  for  the  past  35  years.  At 
one  time,  this  was  conducted  in  Cook  Coun- 
ty Hospital  using  actual  patients  of  the  hos- 
pital. However,  changes  in  the  hospital 
population,  coupled  with  the  greatly  in- 
creased number  of  applicants,  led  to  change, 
and  beginning  in  1964,  the  Committee 
adopted  part  III  of  the  National  Board  as 
its  measure  of  clinical  competence.  It  might 
be  mentioned  that  the  grading  is  done  by 
National  Board  standards,  but  in  this  ex- 
amination only,  the  committee  does  not 
adhere  to  a passing  grade  of  75.  For  some 
time  this  cut-off  point  has  been  73.5%.  The 
authority  for  this  is  Sec.  13,  paragraph  7 of 
the  Medical  Practice  Act  which  states: 

“In  the  exercise  of  its  discretion  under 
this  Section,  the  Department  is  empower- 
ed to  consider  and  evaluate  each  appli- 
cant on  an  individual  basis.  It  may  take 
into  account,  among  other  things,  the 
extent  to  which  there  is  or  is  not  avail- 
able to  the  Department,  authentic  and 
definitive  information  concerning  the 
quality  of  medical  education  and  clinical 
training  which  the  applicant  has  had.  As 
amended  by  act  approved  August  11, 
1967.” 

Reciprocity  Procedures 

The  questions  most  often  asked  are  some- 
thing like  these:  Why  require  a test  of 
clinical  competence?  Why  not  simply  re- 
ciprocate with  another  state  willing  to  re- 
ciprocate with  Illinois? 

There  are  a great  many  reasons  why  the 
State  of  Illinois  cannot  do  this  and  why  it 
is  necessary  to  conduct  some  sort  of  screen- 
ing procedure. 

What  is  forgotten  is  the  undeniable  fact 
that  a license  to  practice  medicine  in  one 
state  may  be  economically  much  more  val- 
uable than  a license  in  a sister  state.^  The 
factors  governing  this  are  relative  wealth, 
climate,  transportation  facilities,  hospitals, 
clinics,  medical  and  other  schools,  and  the 
presence  of  certain  cultural  and  recreation- 
al advantages. 

If  a board  in  one  state  attempts  to  over- 
come the  economic  shortcomings  of  that 
state  by  lowering  the  passing  grades  re- 
quired for  licensure  (and  many  states  do 
just  that)  in  an  attempt  to  secure  more 
physicians  for  the  state,  they  should  be  per- 
mitted to  do  so,  even  though,  in  the  opin- 
ion of  many  of  us,  this  is  not  a proper 


solution  to  the  problem  and  does,  indeed, 
tend  to  create  various  standards  of  prac- 
tice in  the  country.  Nevertheless,  it  is  an 
attempt  to  solve  a problem  peculiar  to  a 
given  segment  of  the  United  States. 

As  a matter  of  record,  many  states  have 
not  failed  an  applicant  in  a licensure  ex- 
amination for  ten  or  fifteen  years.  If  the 
State  of  Illinois  simply  rubber  stamped  the 
licenses  of  these  sister  states,  the  time  would 
be  reached  when  all  applicants  would  take 
their  examinations  in  these  states  and  im- 
mediately apply  for  an  Illinois  license.  The 
net  result  would  be  that  the  State  of  Illi- 
nois would  no  longer  be  setting  its  own 
standards  but  would  allow  some  other  state 
to  set  such  standards.  This  is  a “back-door” 
method  of  obtaining  a license  that  is  quite 
familiar  to  most  applicants. 

Of  the  tests  for  clinical  competency,  dur- 
ing this  two  year  period,  615  were  given 
with  94  failures,  or  a rate  of  15.2%.  The 
record  of  each  failure  was  scrutinized  very 
carefully  before  such  was  confirmed. 

Licensure  by  Emminence 

For  many  years,  it  had  seemed  to  mem- 
bers of  the  Medical  Examining  Committee, 
that  it  was  literally  stupid  to  put  certain 
applicants  through  the  routine  expected  of 
others.  There  were  many  men  in  medicine, 
emminent  in  their  fields,  that  were  forced, 
for  legal  reasons,  to  follow  the  customary 
examination  proceedings.  In  1967,  a dis- 
cretionary clause  was  added  to  the  Act  and 
the  Committee  adopted  criteria  for  deter- 
mining emminence.  These  criteria  follow: 

1)  The  applicant  must  be  properly  li- 
censed in  a jurisidiction  recognizing  re- 
ciprocity with  Illinois. 

2)  He  must  be  appointed  to,  or  have 
filled,  professorial  positions  in  responsible 
institutions. 

3)  He  should  be  certified  by  a recognized 
national  board  and  must  be  a member  of 
recognized  professional  and  educational  so- 
cieties. 

4)  He  must  have  contributed  significant- 
ly to  the  literature  of  medicine  as  deter- 
mined by  publication  in  well-recognized 
periodicals. 

5)  The  entire  Medical  Examining  Com- 
mittee must  unanimously  approve  the  de- 
cision. 

6)  The  entire  curriculum  vitae  of  the 
individual  must  be  included  in  the  minutes. 


for  September  1970 


243 


The  Myth  of  Licensure  Requirements 
As  a Deterrent  to  Practice 

One  hears  repeatedly  that  many  qualified 
men  would  practice  in  Illinois  if  it  were 
not  so  difficult  to  procure  a license.  This 
view-point,  in  the  opinion  of  the  Commit- 
tee, is  not  correct  and  is  not  supported  by 
the  evidence  at  hand. 

One  of  the  recent  studies— that  of  the 
Department  of  Health  Manpower  of  the 
American  Medical  Association— was  adopt- 
ed by  the  House  of  Delegates  at  its  Decem- 
ber, 1969,  Clinical  Convention  in  Denver, 
Colorado.^  After  reviewing  in  some  detail 
the  physician  population  ratios  in  all  of 
the  states  the  conclusion  was  reached: 

“From  this  tabulation,  the  council  finds 
no  evidence  which  would  indicate  that  com- 
plete interstate  reciprocity  would  alleviate 
any  current  inequitable  interstate  distribu- 
tion of  physicians  in  the  United  States.” 

A very  detailed  study  appeared  in  1967, 
called  “Medical  School  Alumni.”^  This  trac- 
ed all  living  graduates  of  all  medical  schools 
and  where  they  were  practicing.  For  our 
purpose,  the  figures  between  1960,  and 
1967,  will  be  used.  During  this  period,  the 
five  medical  schools  in  Illinois  graduated 
4,120  individuals.  Of  this  number,  1,404 
(34.0%)  were  practicing  in  Illinois  in  1967. 
This  occurred  despite  the  fact  that  almost 
the  entire  number  of  4,120  individuals  was 
entitled  to  an  Illinois  license  for  the  asking 
by  virtue  of  National  Board  certification. 

A Medical  Practice  Act  Commission  of 
the  Illinois  Legislature^  studied  this  prob- 
lem in  some  depth  between  1959  and  1962, 
and  among  other  things,  reached  much 
the  same  conclusion. 

It  boils  down  to  the  fact  that  a potential 
partner  or  employee  will  accept  the  best 
offer,  everything  considered,  that  is  made. 
Fie  may  use  alleged  difficulties  in  licensure 
as  an  excuse  to  accept  an  offer  in  another 
state,  but  if  careful  checks  are  made,  the 
grass  is  usually  greener  in  the  place  of  his 
final  choice. 

The  Fallacy  of  Many  Examinations 

The  charge  has  been  leveled  that  Illinois 
does  not  examine  continuously  as  other 
states  do.  Let  us  look  at  the  record. 

There  are  only  three  states  that  examine 
four  times  yearly— Illinois,  Nevada  and 
Rhode  Island. 

There  are  two  states  that  examine  three 


times  yearly— Connecticut  and  New  Jersey. 

There  are  four  states  examining  once 
yearly— Alabama,  Mississippi,  Oklahoma 
and  Washington. 

\11  other  states,  including  the  District  of 
Columbia,  conduct  two  examinations  a year. 

With  the  advent  of  the  Federation  of 
State  Medical  Boards’  examination 
(FLEX),  almost  all  of  the  states,  within  a 
few  years,  will  have  two  examinations  a 
year. 

Causes  for  Delay  in  Licensure 

If  the  job  is  to  be  done  correctly,  there 
are  many  sources  of  delay  that  are  almost 
unavoidable. 

In  reciprocity  or  licensure  by  examina- 
tion, it  is  necessary  for  the  Department  to 
obtain  data  directly  from  the  original 
source:  that  is,  the  medical  school  granting 
the  degree,  the  hospital  to  prove  intern- 
ship and  residency,  the  state  to  prove  ade- 
quate licensure,  and  Federation  headquart- 
ers to  verify  FLEX  giades.  It  may  come 
as  a shock  to  some  individuals  that  an 
applicant  must  be  constantly  and  uniform- 
ly checked  to  prevent  fraud. 

Another  source  of  delay  is  National  Board 
certification.  As  an  example,  members  of 
the  Committee  interviewed  and  checked 
applications  of  62  men  during  the  Illinois 
•State  Medical  Society  meeting  in  May.  The 
greater  part  of  these  had  not  yet  completed 
internship.  Therefore,  they  were  provision- 
ally approved,  pending  permanent  certifi- 
cation after  July  1,  by  the  National  Board. 
This  means  each  hospital  involved  must 
testify  to  the  sirccessful  completion  of  the 
internship,  the  National  Board  must  then 
notify  the  individual  states  (and  there  are 
several  thousand  to  process),  and  since  these 
come  trickling  in  day  by  day,  it  is  useless  to 
try  to  process  one  at  a time. 

It  must  be  remembered  that  the  Direc- 
tor cannot  issue  a license  without  the  rec- 
ommendation of  the  Medical  Examining 
Committee  in  writing.  Another  point  is 
often  overlooked;  the  Director  also  admin- 
isters 27  other  professions  and  trades.  In 
addition,  he  runs  the  Illinois  State  Museum, 
and  must  control  research  and  publications 
in  geology,  zoology,  entymology,  botany 
and  related  fields.  He  also  devotes  time  to 
an  office  in  Chicago  and  one  in  Spring- 
field. 

After  the  Director’s  signature  is  obtained. 


2-14 


Illinois  Medical  Journal 


the  clerical  work  of  turning  out  licenses 
begins,  and  this  is  no  short  or  easy  task. 

Conclusion 

Licensure  to  practice  medicine  is  not  a 
simple  subject.  There  are  probably  different 
ways  of  facilitating  some  of  these  steps,  but 
it  must  be  emphasized  and  recommended 
that  proposed  changes  in  the  Medical  Prac- 
tice Act  be  scrutinized  very  carefully,  and 
in  depth,  by  the  Illinois  State  Medical  So- 


ciety before  suggestions  for  change  are  made 
to  the  Legislature.  ◄ 

References 

1.  Resolutions  70M-1  and  70M-2,  House  of  Dele- 
gates, 137:4,S0,  1970. 

2.  Schnepp,  K.  H.,  “Problems  in  Medical  Licen- 
sure,” J.A.M.A.,  211:1189,  1970. 

3.  Proceedings.  A.M.A.  House  of  Delegates.  Den- 
ver. Colorado,  December,  1969. 

4.  Medical  School  Alumni,  1967,  American  Medi- 
cal Association,  Chicago,  1968. 

5.  Shortage  of  Illinois  Physicians  in  General  Prac- 
tice, Memorandum,  Illinois  Legislative  Council 
File  4-416,  December  1962. 


Our  Violent  Society.  By  David  Abraham- 
sen,  M.D.  Funk  & Wagnalls,  New  York, 
$7.95 

Our  Violent  Society  is  a detailed  anal- 
ysis of  the  causes  of  violence  in  the  United 
States  today.  Written  with  clarity  and  ex- 
pertise, it  is  a report  on  why  this  country 
is  the  most  violent  nation  ever  to  become  a 
world  power. 

Using  actual  case  histories  as  examples. 
Dr.  Abrahamsen,  a distinguished  psychi- 
atrist and  social  analyst,  deals  with  the 
roots  of  violence  in  America— on  the  indi- 
vidual and  the  national  levels.  Separate 
chapters  deal  with  manifest  violence,  hid- 
den violence,  racial  violence,  sex  and  vio- 
lence, instinctive  and  learned  aggiession, 
Lee  Harvey  Oswald  and  other  political 


public 

affairs 

library 

reuieuis 


assassins,  the  American  Dream,  detection  of 
the  potentially  violent  person,  and  the 
means  to  a calmer,  healthier  society. 

Our  Violent  Society  is  based  on  Dr. 
Abrahamsen’s  extensive  research  in  the 
field  of  violence  and  crime,  including  his 
work  at  the  Psychiatric  Institute  of  Colum- 
bia University,  as  consultant  to  the  De- 
partment of  Mental  Hygiene  for  the  State 
of  New  York,  and  as  a member  of  the 
Board  of  Overseers  of  the  Lemberg  Center 
for  the  Study  of  Violence  at  Brandeis  Uni- 
versity. 

In  this  book.  Dr.  Abrahamsen  coldly 
evaluates  the  total  pattern  of  social  turbul- 
ence in  the  United  States  and,  perhaps 
more  important,  presents  reasoned  and 
feasible  long-range  goals  vital  to  our  future 
existence. 


Checklist  to  Avoid  Excess  Auto  Pollution 


Auto  emissions  account  for  over  60%  of 
our  air  pollution.  Each  year  1,000,000  acres 
of  land  are  turned  into  highways,  and  each 
year  traffic  gets  heavier,  slower,  noisier 
and  deadlier. 

Reverse  this  trend  and  don't  drive  into 
the  city;  use  public  transportation  or  better 
yet,  walk  or  bicycle  whenever  possible. 

If  you  must  drive,  you  can  reduce  the 
amount  of  pollutants  your  car  releases  by: 
—making  sure  your  engine  does  not  burn 
excessive  oil 


—changing  oil  and  filters  at  recommend- 
ed intervals 

—replacing  faulty  carburetors  and  fuel 
pump  gaskets 

—checking  your  carburetor  adjustment 
periodically 

—checking  spark  gaps  and  replacing 
spark  plugs  regularly 
—avoiding  excessive  idling 
—avoiding  racing  starts 


for  September  1970 


245 


Paul  R.  Ehrlich : 


A biologist's  remarks 
on  the 

“population  explosion” 


Bv  Michaelyn  Seoan/Chicago 


“A  declining  death  rate”  is  the  key  to 
the  problem  ol  over-popidation  conlronting 
us  today,  according  to  Paul  R.  Ehrlich, 
Stanlord  University  professor  of  biology, 
and  author  of  the  controversial  book.  The 
Population  Bomb.  (Ballantine  Books,  Inc., 
N.Y.,  $0.95) 

Addre,ssing  his  remarks  at  a “teach-out” 
held  in  conjunction  with  the  First  Nation- 
al Congress  on  Optimum  Population  and 
Environment,  in  June,  in  Chicago,  Ehrlich 
briefly  outlined  how  today’s  over-alnind- 
ance  of  people  came  about,  and  discussed 
the  possibilities  o]jen  to  curb  this  prob- 
lem. 

The  Past  and  Present 

Ten  thoirsand  years  ago— approximately 
8000  B.C.— in  the  Western  part  of  Asia, 
man  laid  aside  his  weapons  for  hunting  and 
picked  up  the  implements  nece.ssary  for 
farming,  d’his  “agricultural  revolution” 
enabled  man  to  grow  his  own  food  and 
store  it,  w'ith  the  result— a decline  in  the 
death  rate  via  this  newly  found  form  of 
stability,  and  the  beginning  of  the  “attack” 
on  the  ecological  life  support  systems  of 
the  Earth. 

Tin  ee  and  one-quarter  billion  people  now 
inhabit  the  Earth,  with  an  increase  of  70 
million  each  year.  The  ecological  attack, 
begun  ten  thousand  years  ago,  continues, 
draining  our  resources,  and  in  effect,  “steal- 
ing from  our  children.” 

Only  recently  have  Americans  learned 
that  many  millions  of  their  own  fellow  cit- 
izens go  to  bed  hungry  every  night,  stated 


Ehrlich.  Mention  of  the  word,  “starvation” 
brouoht  to  mind  countries  such  as  India, 
or  more  recently  Biafra. 

“The  concept  of  two  billion  people  liv- 
ing on  this  planet  without  adequet  diets 
truly  staggers  the  imagination.  How  can 
it  be  that  10-20  million  people,  mostly 
children,  are  starving  to  death  each  year 
while  we  pay  some  farmers  not  to  grow 
food?,”  Ehrlich  stated.  He  explained  this 
“surplus”  food  now  produced  is  a surplus 
in  that  it  is  more  food  than  people  can 
afford  to  buy,  and  not  more  than  they  can 
eat. 

Environmental  Deterioration 

In  terms  of  environmental  deterioration, 
Ehrlich  outlined  the  effects  of  over-popula- 
lion: 

• Life  expectancy  will  be  shortened. 

• Poisons  will  a,ssault  the  life  supporting 
.systems— e.g.  photo-synthesis— that  we 
rely  on. 

• The  haze  from  agricultural  dust  is 
the  biggest  source  of  air  pollution, 
with  the  automobile  and  industry  con- 
tributing factors. 

• Air  pollution  is  causing  the  Earth 
to  cool,  thereby  changing  weather  con- 
ditions, which  in  turn  affect  agricul- 
tural j^roduction. 

• A world  wide  plague— though  remote 
sounding— would  result  from  the  equa- 
tion: more  people=more  disease.  With 
this  excellent  transport  system— people 
—natural  mutations  would  occur  and 


246 


Illinois  Medical  Journal 


the  possibility  of  animal  viruses  being 
transferred  to  men  could  come  about. 

• And  finally,  with  the  per  capita  slice 
of  resources  in  danger,  a thermonu- 
clear war  between  nations  of  starving 
people  would  occur. 

Global  Situations 

Population  control,  contrary  to  public 
thought,  must  begin  in  White  America, 
according  to  Ehrlich.  “Blacks  are  the  vic- 
tims of  the  polhiting  done  by  White  Amer- 
ica,” he  stated.  Ehrlich  emphasized  that 
“no  black  individual  should  have  to  listen 
to  any  whites  until  the  black  man  can  be 
treated  with  the  full  rights  accorded  white 
citizens  of  this  society.”  “People  cannot  be 
expected  to  save  a world  which  shows  them 
no  interest,”  he  concluded. 

Ehrlich  called  for  an  end  to  racism  and 
war  in  solving  the  problem  of  over-popula- 
tion. Changes  must  come  about  in  the 
world  organization  structure,  where  men 
are  willing  to  work  beside  one  another  in 
solving  their  common  problems. 

“In  the  nations  that  most  of  us  prefer 
to  label  with  the  euphemism  ‘underdevel- 
oped,’ but  which  might  just  as  accurately 
be  described  as  ‘hungry,’  the  people  will 
be  unable  to  escape  from  poverty  and  mis- 
ery unless  their  poptdations  are  controlled. 
With  the  populations  of  these  nations  doub- 
ling every  20-30  years,  in  order  to  maintain 
present  living  standards,  in  twm  decades, 
everything  must  be  duplicated— agricultural 
production,  doctors,  homes,  imports,  etc.  It 
is  problematical  whether  the  United  States 
coidd  accomplish  a doubling  of  its  facili- 
ties in  20  years,  and  yet  the  LTnitcd  States 
has  abundant  capital,  the  world’s  finest  in- 
dustrial base,  rich  natural  resources,  excel- 
lent communications,  and  a popidation 
virtually  100%  literate,”  Ehrlich  states  in 
his  book,  PoptiLATioN  Resources  Environ- 
ment, Issues  In  Human  Ecology. 

In  developed  countries,  such  as  the  So- 
viet Lin  ion,  which  ranks  second  in  over- 
population, and  Japan,  ranking  third,  the 
cpiality  of  life  is  being  dramatically  over- 
loaded as  these  countries  struggle  to  main- 
tain affluence  and  grow  more  food,  which 
in  turn  leads  to  environmental  deteriora- 
tion, notes  Ehrlich. 

“The  air  grows  more  foul  and  the  water 
more  undrinkable  each  year.  Rates  of  drug 
usage,  crime,  and  civil  disorder  rise  and 


individual  liberties  are  progressively  cur- 
tailed as  governments  attempt  to  maintain 
order  and  public  health.”  Ehrlich  stated, 
“But  the  global  polluting  activities  of  the 
developed  countries  are  even  more  serious 
than  their  internal  problems.” 

He  summed  up  the  situation:  “The  peo- 
ple traveling  first-class  are,  without  think- 
ing, demolishing  ‘Spaceship  Earth’s’  already 
overstrained  life-support  systems.” 

Population  Control 

“Think  of  society’s  population  as  a whole 
in  planning  your  family.  Quality  of  our 
children  and  not  cpiantity  shoidd  be  the 
prime  objective  of  today’s  parents  through 
better  diet  and  more  educational  oppor- 
tunities.” Ehrlich  explained  that  it  would 
take  twenty  generations  before  a genetic 
trait  of  high  quality  would  show  up  in  a 
child. 

He  noted  that  pressure  must  be  taken 
off  women  to  have  children,  and  emphasis 
must  be  placed  on  supplying  those  they 
already  have  with  the  necessary  essentials. 

An  advocate  of  male  contraception,  Ehr- 
lich encouraged  vasectomies  for  men;  “Lots 
of  men  are  trying  very  hard  to  keep  wom- 
en from  having  children  through  birth 
control,”  he  stated. 

Directing  his  attack  to  the  medical  pro- 
fession, Ehrlich  questioned  the  quota 
placed  on  women  admitted  to  medical 
schools,  in  view  of  the  severe  shortage  of 
doctors  in  existence.  He  also  questioned  the 
talent  not  being  tapped  in  the  black  popu- 
lation for  medical  personnel. 

Summary 

“The  next  decade  will  determine  man’s 
fate  as  an  evolutionary  failure,”  Ehrlich 
stated.  He  offered  the  following  recom- 
mendations for  a positive  approach  to  the 
population  problem: 

• Apply  political  pressure  to  induce  the 
United  States  government  to  assume  its 
responsibility  to  halt  the  growth  of  the 
American  population. 

• De-develop  the  U.S.  by  bringing  our 
economic  system— particularly  our  patterns 
of  consumption— into  line  with  the  realities 
of  ecology  and  the  world  resource  situa- 
tion. 

• Once  the  U.S.  has  begun  its  own  clean 
iqr  program,  it  can  turn  its  attention  to 
the  development  of  other  countries.  ◄ 


for  September  1970 


247 


Groups  to  Join 

Following  is  a listing  of  the  names  and  addresses  of 
just  a few  of  the  pollution,  ecology,  population,  and 
conservation  groups  you  might  be  interested  in  con- 
tacting either  to  join  or  to  receive  information. 


Clean  Air  Co-ordinating  Committee 
1440  West  Washington  Boulevard 
Chicago,  Illinois  60607 

CAP— The  Campaign  Against  Pollution 
65  East  Huron  Street 
Chicago,  Illinois  60611 

Great  Lakes  Chapter  of  Sierra  Club 
c/o  Mrs.  Margaret  V.  Robuck 
1248  West  87th  Street 
Chicago,  Illinois  60620 

Illinois  Audubon  Society 
Field  Museum  of  Natural  History 
Roosevelt  Road  & Lake  Shore  Drive 
Chicago,  Illinois  60605 

DiiPagc  Audubon  Society 
Dr.  Russell  Mister,  President 
1006  North  President 
Wheaton,  Illinois  60187 

I/aak  Walton  League  of  America 
1326  Waukegan  Road 
Glenview,  Illinois  60025 

Nature  Conservancy 
1900  Dempster 
Evanston,  Illinois 

John  Muir  Institute  for  Environmental  Studies 
c/o  Dick  Norgard 
5107  S.  Blacks  tone 
Chicago,  Illinois  60615 

Lake  County  Soil  Conservation  District 
P.O.  Box  186 

Lake  Zurich,  Illinois  60047 

Open  Lands  Project 
Gunnar  Peterson,  Director 
53  West  Jackson  Boulevard 
Chicago,  Illinois  60604 


Planned  Parenthood  Assn. 

185  North  Wabash 
Chicago,  Illinois  60601 

Zero  Population  Growth 
c/o  Mrs.  Robert  Coburn 
6019  South  Ingleside  Drive 
Chicago,  Illinois 

Zero  Population  Growth 

Northwest  Suburban 

Mrs.  E.  Maynard  Beal 

587  Laurel  Street 

Elk  Grove  Village,  Illinois  60007 

Zero  Population  Growth 

367  State  Street 

Los  Altos,  California  94022 

Science  Info.  Speakers’  Bureau 
Dr.  J.  Joseph  Levin 
Chicago  Medical  School 
2020  West  Ogden  Avenue 
Chicago,  Illinois 

Local  Chapters  of  League  of 
Women  Voters  frequently  are 
active  in  pollution  fight 

Friends  of  the  Earth 

30  East  42nd  Street 

New  York,  New  York  10017 

Campaign  to  Check  the 
Population  Explosion 
60  East  42nd  Street 
New  York,  New  York  10017 

Forest  Preserve  District  of  Cook  County 
County  Building 
Chicago,  Illinois 


Legislators  to  Write 


Following  is  a listing  of  members  of  Congress  to 
whom  you  can  write  and  tell  your  concern  over  the 
pollution  crisis. 


House  of  Representatives 

Committee  on  Agriculture  (W.  R.  Poage,  Chairman) 
Subcommittee  on  Forests  (John  L.  McMillan,  Chairman) 
Committee  on  Appropriations  (George  H.  Mahon,  Chair- 
man) 

Subcommittee  on  Interior  and  Related  Agencies  (Julia 
Butler  Hansen,  Chairman) 

Subcommittee  on  Public  Works  (Michael  J.  Kirwan, 
Chairman) 

Committee  on  Government  Operations  (William  L.  Daw- 
son, Chairman) 

Subcommittee  on  Conservation  and  Natural  Resources 
(Henry  Reuss,  Chairman) 

Committee  on  Interior  and  Insular  Affairs  (Wayne  N. 
Aspinall,  Chairman) 

Subcommittee  on  National  Parks  and  Recreation  (Roy 
A.  Taylor,  Chairman) 


Senate 

Committee  on  Agriculture  and  Forestry  (Allen  J.  Ellen- 
der.  Chairman) 

Subcommittee  on  Soil  Conservation  and  Forestry  (James 
O.  Eastland,  Chairman) 

Committee  on  Appropriations  (Richard  B.  Russell,  Chair- 
man) 

Subcommittee  on  Department  of  the  Interior  and  Re- 
lated Agencies  (Alan  Bible,  Chairman) 

Sul)committee  on  Public  Works  (Allen  J.  Ellender, 
Chairman) 

Committee  of  Commerce  (Warren  G.  Magnuson,  Chair- 
man) 

Subcommittee  on  Energy,  Natural  Resources  and  the 
Environment  (Philip  A.  Hart,  Chairman) 

Committee  of  Interior  and  Insular  Affairs  (Henry  M. 
Jackson,  Chairman) 


248 


Illinois  Medical  Journal 


Subcommittee  on  Public  Lands  (Walter  S.  Baring, 
Chairman) 

Committee  on  Merchant  Marine  and  Fisheries  (Edward 
A.  Gormatz,  Chairman) 

Subcommittee  on  Fisheries  and  Wildlife  Conservation 
(John  D.  Dingell,  Chairman) 

Committee  on  Public  Works  (George  FI.  Fallen,  Chair- 
man) 

Subcommittee  on  Rivers  and  Harbors  (John  A.  Blatnik, 
Chairman) 

Subcommittee  on  Roads  (John  C.  Kolucznski,  Chairman) 


Subcommittee  of  Parks  and  Recreation  (Alan  Bible, 
Chairman) 

Committee  on  Public  Works  (Jennings  Randolph,  Chair- 
man) 

Subcommittee  of  Air  and  Water  Pollution  (Edmund 
S.  Muskie,  Chairman) 

Subcommittee  on  Flood  Control— Rivers  and  Harbors 
(Stephen  M.  Young,  Chairman) 

Subcommittee  on  Public  Roads  (Jennings  Randolph, 
Chairman) 


Support  anti-pollution  bond  issue  Nov.  3 


Governor  Richard  B.  Ogilvie  has  asked 
for  ISMS’  support  on  the  $750  million  anti- 
pollution bond  issue  on  the  ballot  Novem- 
ber 3. 

The  bond  will  enable  the  state  to  pay 
25%  of  the  cost  of  constructing  or  improv- 
ing more  than  400  municipal  and  sanitary 
district  sewage  plants  already  planned  and 
authorized,  which  are  vital  for  cleaning  up 
the  streams,  rivers  and  lakes  of  Illinois. 

Illinois  needs  sewage  treatment  improve- 
ments costing  $2.2  billion  over  the  next  10 
years  to  comply  with  standards  established 
under  the  federal  Water  Quality  Act  of 
1965. 

A 25%  state  contribution  would  also 
open  the  way  for  increasing  any  federal 
grant  from  a 30%  share  to  a 50-55%  one. 

Illinois  is  one  of  the  few  major  industrial 
states  which  presently  offers  no  state  assist- 
ance to  local  government  for  pollution 


control. 

Currently  pending  are  488  projects  down- 
state,  plus  various  others  serving  eight 
drainage  basins  in  the  Chicago  Sanitary 
District.  These  projects  will  enable  Illinois 
to  comply  fully  with  the  water  quality 
standards  established  under  the  federal 
Water  Quality  Act. 

Presently  90%  of  the  mileage  of  the 
Calumet  River  fails  to  meet  those  stand- 
ards; 80%  of  the  Illinois  River;  and  40% 
of  the  Rock  River.  It  is  estimated  that  sew- 
age causes  approximately  70%  of  the  pol- 
lution problem  in  streams  and  lakes,  com- 
pared to  30%  contributed  by  industry. 

A bond  issue  is  needed  because  compre- 
hensive long-range  planning  cannot  rely  on 
annual  appropriations  from  the  legislature. 
The  bond  issue  will  not  require  any  new 
taxes,  since  the  bonds  will  be  paid  off  from 
general  state  revenues. 


Professionals  vs  Communities 

The  health  professionals  still  meet  this  kind  of  problem,  but  now  they 
also  are  confronted  with  the  other  extreme.  Some  communities  are  un- 
happy at  the  rate  of  progress  which  has  been  achieved  by  professionals. 
They  see  a great  deal  of  action,  but  very  little  progress.  This  is  especially 
true  in  the  inner  city.  They  see  a large  amount  of  money  being  spent  on 
programs,  but  they  do  not  see  enough  understanding  of  people.  They  are 
tired  of  the  indignities  which  they  receive  from  health  professionals.  The 
difference  now,  however,  is  that  they  are  not  willing  to  take  this  passively. 
Some  segments  of  the  community  are  angry  and  today  the  professional 
will  be  reduced  to  impotence,  not  because  he  is  alone,  but  more  likely  be- 
cause the  community  has  demanded  full  control.  (M.  Alfred  Haynes:  Pro- 
fessionals And  The  Community  Confront  Change,  Am.  J.  or  Public  Health 
60:3  [March]  1970,  pages  519-523.) 


for  September  1970 


249 


Surgery  Annual  (Volume  1)  By  Philip 
Cooper,  M.D.,  editor,  Appleton-Century- 
Crolts,  New  York,  1969. 

The  1969  Surgery  Annual  was  conceived 
as  a current  review  ol  recent  advances  or 
modifications  in  practical  surgical  manage- 
ment and  in  the  basic  sciences  as  related 
to  surgery.  The  chapter  headings  cover  a 
wide  variety  ol  subjects  ol  interest  to  stu- 
dents and  house  stall.  All  ol  the  biblio- 
graphies are  current  and  as  such  will  be 
a heljilid  starting  point  lor  the  surgeon  in 
search  ol  answers  to  sjiecific  problems. 
Topics  ol  general  interest  covered  in- 
elude  physiologic  monitoring  and  care  of 
seriously  ill  surgical  patients,  cardiopul- 
monary resuscitation,  shock,  antibiotics, 
gastric  physiology  and  cancer  chemothera- 
py. Both  practical  and  theoretical  ad- 
vances are  surveyed.  Transplantation  and 
organ  preservation  are  also  included  in  the 
chapters  of  special  interest.  These  topics 
are  presented  extremely  well.  Orthopedic 
stirgery  is  included,  with  such  topics  as 
arthrography,  radioactive  tracer  examina- 
tions ol  bone,  new  concepts  ol  limb  ampu- 
tation and  musculoskeletal  injtuies.  There 
are  chapters  on  cardiac  surgery  and  neuro- 
surgery also. 

Perhaps  the  major  failing  ol  the  StiRGERY 
Annual  ol  1969  is  the  lack  of  in-depth  cov- 
erage ol  many  of  the  topics  included,  while 
the  major  strength  is  the  fact  that  the  ma- 
terial is  all  current  and  up  to  date. 

Julius  Conn,  Jr.,  M.D. 

A Guide  to  Dermatohistopathology.  By 
Hermann  Pinkus,  M.D.,  M.S.  and  Amir 
H.  Mehregan,  M.D.  546  pages.  Appleton- 
Century-Crofts,  Educational  Division, 
Meredith  Corporation,  New  York,  New 
York,  1969.  Price  $20.00.  403  illustrations. 
This  book  as  pointed  otit  by  the  authors 
is  intended  to  guide  the  students  and  resi- 
dents in  dermatology  and  pathology  in 


their  study  of  diseases  of  the  skin. 

The  book  is  divided  intc*  seven  sections; 
entitled:  General  Part,  Sttperficiali  Infl'atn:' 
matory  Processes,  Deep,  Inflammatory 
Processes,  Granulomatous  Inflammation 
and  Proliferation,  Metabolic  and  Other 
Non  inflammatory  Dermal  Diseases,  Non- 
neoplastic Epithelial  and  Pigmentary  Dis- 
orders and  Malformation  and  Neoplasia. 

It  is  an  orderly  and  systematic  presenta- 
tion ol  the  subject  starting  with  pitfalls  and 
artifacts  produced  by  histologic  technique 
or  in  the  course  of  biopsy.  Then  normal 
skin  histology  is  reviewed  through  the 
liberal  use  of  diagrams  and  microjihoto- 
graphs  before  going  into  the  various  disease 
entities. 

In  contrast  to  the  standard  textbooks  on 
the  skin,  the  authors  have  concentrated  on 
enumerating  the  histologic  findings  which 
in  their  own  experience  aid  in  making  the 
diagnosis,  rather  than  including  clinical 
descriptions  of  the  lesions.  Moreover,  the 
authors  admit  that  the  bibliography  is; 
limited  mainly  to  most  of  their  ]ttiblica-. 
tions  except  where  indicated,  since  the: 
views  expres,sed  are  their  own.  The  illustra- 
tions are  very  clear  and  well-chosen. 

The  book  is  of  definite  value  to  the  stu- 
dents and  residents  in  both  Dermatology 
and  Pathology. 

Paid  B.  Putong,  M.D. 

Diseases  of  the  Chest  (3rd  Edition).  By 
H.  Corwin  Hinshaw,  799  pages,  illus- 
trated. Philadelphia,  London  and  To- 
ronto, W.  B.  Saunders  Co.,  1969. 

The  third  edition  of  Diseases  of  the. 
Che.st  by  Hinshaw  continues  to  be  a well 
written  and  comjrrehensive  textbook  on 
medical  chest  diseases.  Moreover,  the  ma- 
jor surgical  indications  in  diagnosis  and 
treatment  are  adequately  presented. 

The  excellent  organization  of  the  sub- 
ject matter  is  welcome  in  that  many  of  the 


250 


Illinois  Medical  Journal' 


common  defects  of  a multiauthored  text 
have  been  avoided.  The  presentation  of  the 
various  subjects  is  unified,  and  the  space 
allotted  for  each  is  commensurate  with  its 
importance  in  the  practice  of  medicine. 
The  references  are  limited  in  number,  but 
in  most  instances  key  articles  have  been 
chosen  for  further  reading  so  desired. 

One  of  the  outstanding  features  of  the 
third  edition  is  the  quality  of  the  chest 
roentgenograms  and  other  illustrative  ma- 
terial throughout  the  text.  The  chest  roent- 
genograms are  among  the  best  the  reviewer 
has  seen  in  any  textbook.  The  publisher  is 


to  be  commended  on  the  exceedingly  clear 
and  beautiful  reproductions  of  these  roent- 
genograms. 

The  text  material  is  presented  on  a prac- 
tical level  throughout.  The  chapters  on 
“Clinical  Evaluation  of  Radiologic  Exami- 
nations” and  “Segmental  Anatomy  of  the 
Tracheobronchial  Tree  and  Lungs”  will  be 
of  benefit  to  anyone  who  reads  them. 

This  text  may  be  highly  recommended 
for  the  student,  house  officer  and  nonspe- 
cialist. Surgeons  also  will  find  this  text  to 
be  a worthwhile  review  of  the  general  sub- 
ject of  chest  disease. 

Thomas  W.  Shields,  M.D. 


ILLINOIS 

MEDICAL 

ASSISTANTS 

ASSOCIATION 


REPORT 


Growth  is  a beautiful  word 


By  Leslie  Lee/Chicago 


The  Illinois  Medical  Assistants  Associa- 
tion is  proud  of  the  many  new  chapters  be- 
ing formed  in  our  state  to  help  broaden 
the  educational  horizons  for  your  Medical 
Assistant. 

Through  outstanding  speakers,  films  and 
dramatizations  each  county  society  brings 
to  its  members  the  unique  opportunity  of 
learning  experiences,  emphasizing  some 
facet  of  its  work.  We  are  a non-profit  or- 
ganization promoting  the  practice  of  good 
human  relations  between  doctor,  patient 
and  medical  assistant.  Our  American  As- 
sociation of  Medical  Assistants  membership 
in  our  15th  year  encompasses  approximate- 


ly 15,000  members  throughout  the  fifty 
states. 

Our  goals  are  to  maintain  and  advance 
standards  of  professional  employment 
among  Medical  Assistants  and  to  render 
loyal  and  efficient  service  to  the  medical 
profession  and  to  the  public. 

Membership  is  open  to  persons  employed 
six  months  or  longer.  If  your  Medical  As- 
sistant is  not  a member,  now  is  the  time 
to  consider  the  many  advantages.  Both  you. 
Doctor,  and  your  Medical  Assistant  will 
benefit  from  your  Association.  Please  con- 
tact Mrs.  Norma  Domanic,  150  Ash  Street, 
New  Lennox,  111.  60451  or  Mrs.  Vivian 
Kraft,  RR  #2,  Normal,  Illinois  61761. 


Sign  of  the  Times 

"NEW  YORK— (UPl)— The  company's  (NBC)  latest  offer  of  a $50-a-week  salary 
increase  and  shorter  work  weeks  was  rejected.  . . . The  $50  wage  increase  would 
have  made  NBC  technicians  the  highest  paid  among  the  three  major  networks." 
—Washington  Star,  May  1. 


for  September  1970 


251 


Rx  Products 
Index 


IF  YOU  NEED 


• TO  REDUCE  INCOME 
TAXES 


• A POTENTIAL  LONG- 
TERM APPRECIA- 
TION OF  YOUR 
INVESTMENT— 

Let  us  send  you  without  eost  our 
«lata  about  tax  shelters  and  limited 
partnerships  for  oil  and  gas  ex- 
ploration. 


•Note:  This  announcement  is  neither  an 
offer  to  sell  nor  a solicitation  of  any 
offer  to  buy.  Limited  partnership  sub- 
scriptions are  offered  only  by  means  of 
the  Prospectus. 


•Note:  We  will  be  pleased  to  provide 
a speaker  for  special  association  or  study 
club  programs.  Call  (collect)  415-433- 
7100. 


GEOTEK  RESOURCES  FUND,  Inc. 

315  Montgomery  St.,  Son  Francisco  94104 


GEOTEK  RESOURCES  FUND,  INC. 

315  Montgomery  St.,  Son  Francisco  94104 

Please  send  me  data  on  tax  shelters: 


name 


street 


city  state  rip 


Allbee  with  C 254 

A.  H.  Robins  Co. 

Achromycin  202-203 

Achrocidin  186 

Achrostatin  281 

Lederle  Laboratories 

Aventyl  HCL  198-199 

Eli  Lilly  and  Company 

Dicarbosil  280 

Arch  Laboratories 

Equanil  .272 

Wyeth  Laboratories 

Dimetapp  193 

Donnatal 253 

A.  H.  Robins  Co. 

Ilosone  214 

Eh  Lilly  and  Company 

Librium  262-263 

Roche  Laboratories 

Mylanta  206 

Stuart  Pharmaceutical  Div. 

Atlas  Chemical  Corp. 

Neosporin  Ointment  ...213 

Burroughs  Wellcome  Co. 

Noludar  — 204-205 

Roche  Laboratories 

Orenzyme/AVC  259,  260 

National  Drug  Co. 

Plastipak  195,  196 

Becton,  Dickinson  & Co.,  Inc. 

Pro-Banthine  2nd  Cover 

G.  D.  Searle  & Co. 

Serentil  209-212 

Sandoz  Pharmaceutical  Div. 

Sandoz,  Inc. 

Sinequan 265-268 

Pfizer  Laboratories  Div. 

Pfizer  Inc. 

Tepanil  /Quinamm 189,  190 

National  Drug  Co. 

Trocinate  3rd  Cover 

Wm.  P.  Poythress 

Valium  Back  Cover 

Roche  Laboratories 

Vasodilan  CVD  200-201 

Mead  Johnson  Laboratories 


252 


Illinois  Medical  Journal 


A service  of  the  Public  Relations  and  Economics  Division 


By  Joseph  J.  Lotharius 


Will  MDs  Become  Plans  for  hospital-based  prepaid,  closed  panel  group 

Hospital  Employees?  practice  programs  are  being  discussed  by  medical  staffs 

in  more  than  a dozen  Illinois  hospitals.  A study  prepared 
by  one  of  the  hospitals  calls  the  establishment  of  such  a 
group  plan  necessary  for  its  very  survival.  Several  down- 
state  hospitals  think  that  8 to  12  physicians  are  required 
to  make  a group  practice  feasible.  Still  to  be  determined 
in  most  of  the  studies  currently  being  done  is; 

• What  are  the  financial  benefits  to  the  hospital? 

• How  does  the  physician  get  paid? 

• What  type  of  relationship  would  exist  between  hos- 
pital ancl  doctor  (would  it  be  an  employer-employee 
relationship)? 

• Would  an  insurance  carrier  be  sought  to  underwrite 
such  a prepaid  plan? 

• Who  would  perform  the  claims  processing? 

• Finally,  how  would  an  AMA  policy  relating  to  MD- 
hospital  relationship  be  interpreted? 

The  policy  reads  “A  physician  should  not  dispose  of 
his  professional  attainments  or  services  to  any  hospital, 
corporation  or  lay  body  by  whatever  name  called  or  how- 
ever organized  under  terms  or  conditions  which  permit  the 
sale  of  the  services  of  that  physician  by  such  agency  for 
a fee.” 


How  Will  Your 
Practice  Be  Affected? 


How  will  your  practice  be  affected  by  new  innovations 
in  health  care  delivery?  Find  out  by  attending  the  ISMS 
Leadership  Conference  to  be  held  at  the  Continental  Plaza 
hotel  in  Chicago  on  Sunday,  November  15.  Prominent 
speakers  will  discuss  the  major  proposals  for  health  care 
delivery  and  bring  these  concepts  into  sharp  focus  for  ISMS 
members.  The  Conference  will  explore  the  physician’s  role 
in:  Foundations  for  Medical  Care;  Health  Maintenance 
Organizations;  and  hospital-based  group  practice  programs. 
^V’atch  for  further  details  in  the  next  few  weeks  and  re- 
serve the  date— NOVEMBER  \b—now! 


ISMS  Board  Recognizes  ISMS  Trustees  approved  a recommendation  to  recognize 
Foundation  Concept  Eoundations  for  Medical  Care  as  another  system  for  health 

care  delivery  in  Illinois.  The  Board’s  new  Committee  on 


for  September  1970 


255 


Health  Care  Financing  will  study  the  Foundation  concept 
to  determine  the  feasibility  of  implementing  such  a pro- 
gram by  the  Medical  Society.  The  Committee  will  also 
consider  pre-paid  hosjaital  based  group  practice  plans  pres- 
ently being  discussed  by  many  physicians  throughout  Il- 
linois. 

Consumei*  Drug  Significant  facts  recently  released  by  the  Pharmaceutical 

Declining  Manufacturers’  Association  (PMA)  reveal  that  the  average 

retail  cost  of  a prescription  is  |3.68,  75%  are  priced  at 
less  than  $4.50;  consumer  costs  for  prescription  drug  prod- 
ucts are  declining  as  a share  of  the  total  medical  care 
dollar;  pharmaceutical  manufacturers  will  spend  an  esti- 
mated $600  million  for  research  and  development  during 
1970;  the  national  output  of  the  U.S.  has  been  expanded 
over  $7  billion  in  a single  year  as  a result  of  improved 
medical  treatment  and  new  medicines  for  just  four  major 
diseases. 

The  PMA  is  a non-profit  trade  association  comprised 
of  some  120  companies  producing  95%  of  the  nation’s 
prescription  drugs. 

A Study  of  Health  Care  HEW  grant  of  $727,000  has  been  awarded  to  the 

In  the  ^70s  Center  for  Health  Administration  Studies  (CHAS)  of  the 

University  of  Chicago’s  Graduate  School  of  Business.  The 
grant  will  finance  a survey  analyzing  the  medical  experi- 
ence ol  the  Amciican  people  in  1970— their  use  of  health 
services,  the  cost  of  these  services,  and  methods  for  pay- 
ment for  them.  Among  other  findings,  the  survey  will  dis- 
close the  impact  of  Medicare  and  Medicaid  on  the  nation’s 
health  and  its  medical  delivery  system.  CFIAS  expects  the 
study  will  take  tliree  years  to  complete.  A preliminary 
re])ort  is  expected  in  July,  1971. 


Health  Care 

Those  physicians  who  tend  to  look  upon  the  Medicare  law  as  the  turn- 
ing point,  in  public  policy  regarding  health,  are  merely  viewing  a small 
arc  of  the  wide  circle  of  events,  which  already  have  been  and  are  yet  to 
be  generated  as  a consequence  of  this  legislation,  which  passed  virtually 
unnoticed  and  unheralded  in  the  plethora  of  health  legislation  of  the  '60s. 

The  Comprehensive  Health  Planning  and  Public  Health  Service  Amend- 
ments of  1966,  did  indeed  formulate  the  principles  for  the  design  of  a 
framework  around  which  new  directions  and  courses  of  action  would  be 
developed  for  the  health  care  of  the  American  public.  But,  more,  it  intro- 
duced new  concepts  and  structures  which  would  assure  the  broadest 
voluntary  involvement  of  Community  forces  and  institutions  in  its  imple- 
mentation. If  there  are  any  doubts  regarding  the  intent  of  Congress,  a 
single  sentence  in  the  preamble  to  the  law  should  dispel  them.  It  reads: 

"The  Congress  declares  that  fulfillment  of  our  national  purpose  depends 
on  promoting  and  assuring  the  highest  level  of  health  attainable  for 
every  person,  in  an  environment  which  contributes  positively  to  healthful 
individual  and  family  living."  (Malcolm  C.  Todd.:  The  Physician  and  Com- 
prehensive Health  Planning.  California  Med.  [Apr.]  1970.  112:68-70.) 


256 


Illinois  Medical  Journal 


Editorial  Board 

Frederick  Steigman,  M.D.,  Chicago,  Chairman 
Gastroenterology 
Edward  DuVivier,  M.D.,  Alton 
Pediatrics 

Arthur  DeBoer,  M.D.,  Chicago 
Cardiac  Surgeon 

Donald  L.  Unger,  M.D.,  Des  Plaines 
Allergy 

Joseph  H.  Kiefer,  M.D.,  Chicago 
Urology 

Clarence  J.  Mueller,  M.D.,  Sterling 
General  Surgery 
Robert  E.  Lane,  M.D.,  Chicago 
Ob-Gyn 

David  Shoch,  M.D.,  Chicago 
Ophthalmology 

Ernest  Lowenstein,  M.D.,  Mt.  Carmel 
Family  Practice 
Newton  DuPuy,  M.D.,  Quincy 
Ob-Gyn 

Thomas  J.  Collins,  M.D.,  Chicago 
Pathology 

Arkell  M.  Vaughn,  M.D.,  Chicago 
Surgery 

William  E.  Adams,  M.D.,  Chicago 
Surgery 

L.  Martin  Hardy,  M.D.,  Chicago 
Pediatrics 

Edward  Cruzat,  M.D.,  Chicago 
General  Surgery 

Neil  Allen,  M.D.,  Morton  Grove 

Resident  in  Neurology  and  Surgery 
Contributor  in  Surgery 

John  M.  Beal,  Chicago 
Contributor  in  Radiology 

Leon  Love,  M.D.,  Maywood 
Contributor  in  Cardiology 

John  R.  Tobin,  M.D.,  Maywood 
Contributor  in  Medical  Progress 
Harvey  Kravitz,  M.D.,  Skokie 
Editor:  Theodore  R.  VanDellen,  M.D. 


Publications  Committee 

Board  of  Trustees 

Jacob  E.  Reisch,  M.D.,  Springfteld,  Chairman 
A.  E.  Livingston,  M.D.,  Bloomington 
Warren  W.  Young,  M.D.,  Chicago 


NEW  TOOL  FOR  SOCIAL  CHANGE 


Medical  center  complexes  may  lead  to 
more  subtle  changes  in  the  practice  of 
medicine  than  most  physicians  realize. 
There  is  little  doubt  that  they  will  pro- 
vide medical  care  for  more  people  with 
greater  efficiency.  But  to  do  this,  “hospital 
privileges’’  as  now  practiced  will  be  largely 
a thing  of  the  past.  Medical  teams  will  pro- 
vide community  care  and  someone  at  the 
top  will  dictate  what  services  a physician 
is  most  capable  of  providing.  Doctor  X may 
l)e  told  to  run  the  renal  dialysis,  Y to  de- 
liver the  babies,  and  Z to  run  the  emer- 
gency room  at  night.  The  big  question  is, 
“who  will  tell  whom  what  to  do?” 

Neighborhood  health  centers  are  outside 
medical  center  complexes.  They  could  be- 
come the  vehicles  leading  to  social  and 
medical  change.  These  centers  were  started 
initially  in  response  to  community  discon- 
tent and  the  demands  for  popular  partici- 
pation in,  and  control  over,  the  formation 
of  social  policy.  According  to  Dr.  Eugene 
Feingold,  a political  scientist,  the  Univer- 
sity of  Michigan  School  of  Public  Health, 
the  government,  in  establishing  local  health 
centers,  emphasized  that  its  role  would  in- 
volve participation  rather  than  control.  But 
the  pow'er  struggles  among  members  of  the 
center  and  between  the  center  and  the  com- 
munity has  the  potential  for  changing  es- 
tablished relationships. 

Black  physicians  working  in  the  ghetto 


have  long  served  the  poor  without  cost  or 
at  low  fees.  Now  that  the  poor  are  able  to 
pay  for  care  through  Medicaid,  these  phy- 
sicians feel  they  should  be  paid  for  their 
services.  In  some  areas  the  centers  have 
been  forced  to  operate  with  a staff  of  black 
physicians  drawn  from  the  ghetto.  The  ma- 
jority are  able  to  participate  only  on  a 
]jart-time  basis. 

The  neighborhood  health  center  not  only 
offers  medical  care  but  exerts  economic 
power  as  employer,  bank  depositor,  and 
purchaser  of  goods  and  services.  Some  cen- 
ters also  ojipose  any  attempt  on  the  part 
of  the  local  pharmacists  and  medical  so- 
cieties to  exercise  local  and  national  poli- 
tical influence  to  restrict  their  programs. 

Participation  at  the  community  level  has 
created  some  conflicts.  Whenever  the  cen- 
ter serves  a mixed  community  the  struggle 
for  power  and  rewards  is  ethnically  basfed. 
Power  struggles  between  members  of  the 
health  team  also  result  in  disagreements. 
But  Dr.  Feingold  believes  the  neighbor- 
hood health  centers  may  change  the  indi- 
vidual by  providing  power  to  the  power- 
less and  help  to  make  authority  legitimate 
once  more. 

T.  R.  Van  Dellen,  M.D. 

Reference 

“Health  Centers  as  Vehicles  Leading  to  Social 
Change,”  Public  Health  Reports  (Apr.)  1970, 
page  285. 


for  September  1970 


257 


"Cocked  Shotgun"  On  Highways 

“Raw  defiance  of  law  and  mome-ntary 
demonstrations  of  manhood  with  a car  are 
like  walking  into  a crowd  with  a cocked 
shotgun.  You  don’t  intend  to  kill  anyone, 
and  getting  yourself  messed  up  is  not  at 
all  what  you  had  in  mind.  But  it’s  a cinch 
you’ll  be  a loser  and  so,  tragically,  will  be 
friends  and  total  strangers.  Totally  inno- 
cent friends  and  strangers.’’ 

The  above  paragraph  is  quoted  from 
the  latest  edition  of  the  annual  booklet  of 
highway  accident  statistics  from  The  Trav- 
lers  Insurance  Companies. 

This  “cocked  shotgun’’  went  off  on 
America’s  highways  many  times  in  1969. 
The  annual  survey  of  motor  vehicle  acci- 
dents shows  that  such  mishaps  last  year 
claimed  more  than  56,500  lives  and  injured 


another  4,700,000  men,  women  and  chil- 
dren. 

The  “cocked  shotgun”  was  the  driver  go- 
ing too  fast  for  highway  conditions,  the 
rash  and  carefree  youth,  the  driver  passing 
on  curve  or  hill,  who  didn’t  signal. 

Excessive  speed  continued  to  be  the  Num- 
ber One  Killer,  accounting  for  more  than 
18,700  deaths  and  1,056,000  injuries. 
Thoughtless  driving,  even  at  moderate 
speed,  accounted  for  5,500  deaths— and  the 
greatest  number  of  injuries  (1,267,000). 

Pedestrians  too,  died  in  great  numbers  in 
1969.  Crossing  between  intersections  claim- 
ed 4,040  lives  and  injured  more  than  67,- 
800  persons. 

To  end  this  carnage  on  our  highways, 
everyone  driving  or  walking  must  make 
safety  his  business.  X. 


Artificial  Lung 

A grant  of  $34,753  has  been  awarded  to 
Marquette  School  of  Medicine  by  the  John 
A.  Hartford  Foundation,  Inc.,  New  York 
City,  for  development  of  a new  type  of  arti- 
ficial lung.  Announcement  of  the  one  year 
research  award  was  made  jointly  by 
Ralph  W.  Burger,  foundation  president, 
and  Dr.  Gerald  A.  Kerrigan,  dean  of  the 
medical  school. 

Small  models  of  the  lung  have  been  test- 
ed by  Dr.  Richard  D.  Stewart,  associate 
professor  and  chairman  of  the  Marquette 
department  of  environmental  medicine, 
and  Edward  D.  Baretta,  research  engineer 
in  environmental  medicine.  The  two  men 
have  been  named  as  co-investigators  under 
the  grant. 

The  lung  has  been  tried  with  success  in 
the  laboratory  for  periods  up  to  26  hours. 
The  Hartford  foundation  grant  will  per- 
mit construction  of  a clinical  size  unit,  in- 
tended first  for  laboratory  tests.  When  de- 
velopment reaches  the  stage  of  human  tri- 
al, the  larger  model  is  expected  to  assist  or 
even  take  over  pulmonary  function  for  pa- 
tients with  both  acute  chronic  lung  disease, 
such  as  hyaline  membrane  disease  of  the 
newborn,  pneumonia,  and  possibly  emphy- 
sema. Another  application  would  be  to 
take  over  lung  function  during  surgery. 

The  new  model  will  be  a small  device 
scaled  to  the  size  of  a half-gallon  cylinder 
encasing  thousands  of  fine  silicone  rubber 


to  be  Developed 

tubes.  The  tubes  are  approximately  the 
size  of  darning  thread.  Blood  flowing 
through  the  tubes  receives  oxygen  through 
semi-permeable  walls.  In  similar  fashion, 
carbon  dioxide  passes  out  of  the  blood  and 
is  carried  away  via  an  oxygen  bath  flow- 
ing around  the  tubes.  The  silicone  materi- 
al used  to  construct  the  tubes  is  the  best 
known  man-made  material  for  gaseous  ex- 
change. 

The  first  laboratory  tests  were  done  in 
January  and  February  of  this  year.  In  these 
tests  the  lung  proved  its  ability  to  supply 
measured  amounts  of  oxygen  to  the  blood 
and  to  remove  waste  carbon  dioxide.  The 
amount  of  oxygen  received  via  the  normal 
respiratory  route  was  controlled  to  various 
levels  with  the  oxygen  deficit  made  up  by 
the  artificial  lung.  The  lung  functioned 
well  during  the  several  test  runs,  the  long- 
est being  26  hours.  There  was  no  signifi- 
cant damage  to  the  blood  such  as  occurs 
with  other  oxygenators. 

The  clinical  model  will  be  designed  to 
feed  oxygen  into  the  blood  stream  and  to 
remove  carbon  dioxide,  both  in  amounts 
sufficient  to  sustain  human  life.  Another 
feature  of  the  lung  will  be  the  small 
amount  of  blood  needed  to  “prime”  the 
unit  in  order  to  get  flow  started  through  it. 
Approximately  one  cup  will  be  required 
for  “priming”  the  clinical  model.  Other 
oxygenators  require  several  times  more 
than  this  amount. 


258 


Illinois  Medical  Journal 


The  Exceptional  Parent  Magazine  Due  For 
Release 

The  Exceptional  Parent,  a new  magazine,  by  the  Psy-Ed 
Corporation,  will  be  ready  for  distribution  in  September. 
The  magazine,  unique  among  educational  and  professional 
publications,  will  aim  "to  provide  practical  help  for  the 
parents  of  children  with  disabilities."  It  will  combine  the 
knowledge  of  experts  with  the  day-to-day  experiences  of 
laymen.  The  magazine  will  deal  with  many  issues  that 
affect  the  exceptional  child  and  will  cover  such  topics  as 
the  role  of  the  family,  the  nature  and  role  of  the  various 
professional  groups  with  whom  the  family  is  apt  to  come 
in  contact,  and  the  ways  in  which  certain  aids  can  be 
helpful.  Information  will  be  easily  understandable,  prac- 
tical as  well  as  theoretical.  The  magazine  will  also  pro- 
vide a medium  through  which  parents  can  exchange  ideas, 
share  concerns,  and  discover  new  approaches  to  common 
problems. 

The  founders  and  editors  of  The  Exceptional  Parent  are 
three  professional  colleagues  who  are  practicing  psycholo- 
gists and  university  professors:  Lewis  Klebanoff,  Stanley 
Klein  and  Maxwell  Schleifer. 

Charter  subscriptions  to  The  Exceptional  Parent,  which 
will  have  national  distribution,  are  $6.00  a year.  Further 
information  may  be  obtained  by  writing  The  Exceptional 
Parent,  Box  45,  Newtonville,  Mass.  02160. 


Amniotic  Fluid  Studied  in  Prenatal  Situations 


A method  of  direct  chemical  analysis 
has  been  developed  at  The  University  of 
Chicago  to  detect  diseases  that  cause  phys- 
ical and  mental  abnormalities  in  an  un- 
born baby  up  to  six  months  before  its 
birth. 

This  advance  diagnosis  can  allow  the 
physicians  and  parents  of  abnormal  chil- 
dren to  seek  termination  of  pregnancy 
while  such  a procedure  is  still  simple  and 
safe  or  to  assure  parents  with  potential 
genetic  problems  of  their  child's  normality. 

The  technique  was  developed  by  Dr. 
Reuben  Matalon  and  Dr.  Albert  Dorfman 
of  The  Pritzker  School  of  Medicine. 

"The  technique  involves  inserting  a 
needle  into  the  uterus  and  withdrawing 
a sample  of  the  amniotic  fluid  which  sur- 
rounds and  protects  the  unborn  baby,"  Dr. 
Dorfman  said. 

"This  fluid  can  then  be  analyzed  for  the 
amount  and  composition  of  a group  of 
chemical  compounds  (mucopolysaccha- 
rides). The  presence  of  these  substances  in 


abnormal  amounts  or  in  abnormal  forms 
indicates  that  the  unborn  child  has  a dis- 
ease of  the  connective  tissues  (mucopoly- 
saccharidoses or  Hurler's  syndrome).  This 
disease  causes  severe  mental  retardation 
and  crippling. 

Previously,  amniotic  fluid  has  been  used 
as  a source  for  cells  from  the  unborn 
child.  These  cells  were  cultured,  or  grown, 
and  then  examined  visually  or  chemically 
to  detect  cellular  abnormalities  that  may 
indicate  chromosome  defects,  that  oc- 
cur in  mongolism,  or  chemical  defects  that 
occur  in  inherited  diseases. 

"In  the  past,  all  such  a couple  could 
do  was  to  either  take  their  chances  with 
the  probability  factors  or  refrain  from  hav- 
ing children.  Such  couples  can  now  get 
a definitive  diagnosis  of  their  child's  nor- 
malcy while  they  still  have  the  option  to 
end  the  pregnancy  safely,"  Dr.  Dorfman 
said.  "This  enables  them  to  avoid  bearing 
deformed  children  and  yet  have  as  many 
normal  children  as  they  choose." 


for  September  1970 


261 


The  patient  who  has  had  a myocardial 
nfarction  is  usually  advised  by  his 
)hysician  to  avoid  emotional  excitement. 
yi  too  often  his  family,  acutely 
:oncerned,  transmits  its  anxiety  to  him, 
irging  him  to  “rest,  rest.” 


iow  anxiety  may  interfere 
n a study  of  336  males  who  had 
uffered  at  least  one  myocardial 
nfarction,  Sigler^  reports  that 
nanual  workers  showed  the  lowest 
lercentageof  patients  returning  to 
vork,  compared  to  clerical  workers, 
)usiness  and  professional  men. 

The  author  notes  that  in  many 
ases  the  mere  apprehension  that 
return  to  work  would  shorten  life 
irevents  the  patient  from  resuming 
ctivities.”  It  is  also  well  known 
hat  emotional  disturbance  is 
irobably  the  most  common  cause 
if  cardiac  disability  in 
lostinfarction  cases. ^ 

"he  anxiety  factor  in  both  coronary 
nd  precoronary  patients  has 
ecently  been  discussed  by 
Thomas,"  who  suggests:  “Intensive 
nvestigation  of  the  sources  and 
;inds  of  anxiety,  and  how 
lestructive  forms  of  anxiety  can  be 
dentified  and  relieved  may  be  the 
lext  important  step  in  the 
irevention  of  coronary  heart 
lisease.” 

felief  of  anxiety  with  Librium® 
chlordiazepoxide  HGl)  often 
iroves  a valuable  adjunct  to 
nedical  counsel,  reassurance  and 
he  total  management  program; 
nay  help  prevent  the  postcoronary 
latient  from  regressing  into  a state 
if  invalidism. 

Vs  an  adjunct  in  cardiovascular 
herapy.  Librium® 
chlordiazepoxide  HCl):  Quickly 
elieves  anxiety  of  mild  to  severe 
legree  in  most  cases.  Helps  expedite 
ooperation  m therapeutic  regimen, 
vlay  be  used  concomitantly  with 
ertain  specific  medications  of  other 
lasses  of  drugs,  such  as  cardiac 
dycosides,  antihypertensive  agents 


and  diuretics.  By  relieving  anxiety, 
helps  encourage  productive 
activities.  Has  a wide  margin  of 
safety  and,  in  proper  maintenance 
dosage,  seldom  impairs  mental 
acuity  or  ability  to  function.  Often 
effective  in  extended  therapy, 
usually  without  diminution  of  effect 
or  need  for  increase  in  dosage- 
in  protracted  use,  periodic  blood 
counts  and  liver  function  tests  are 
advisable. 

References:  1.  Sigler,  L.  H.:  Geriatrics,  22:{9) 
97,  1967.  2.  Thomas,  C.  B.:  Johns  Hopkins 
Med.  y„  722:69,  1968. 

Before  prescribing,  please  consult  complete 
product  information,  a summary  of  which 
follows: 

Indications:  Indicated  when  an.xiety,  tension 
and  apprehension  are  significant 
components  of  the  clinical  profile. 
Contraindications:  Patients  with  known 
hypersensitivity  to  the  drug. 

Warnings:  Caution  patients  about  possible 
combined  effects  with  alcohol  and  other 
CNS  depressants.  As  with  all  CNS-acting 
drugs,  caution  patients  against  hazardous 
occupations  requiring  complete  mental 
alertness  {e.g.,  operating  machinery, 
driving).  Though  physical  and 
psychological  dependence  have  rarely  been 
reported  on  recommended  doses,  use 
caution  in  administering  to  addiction-prone 
individuals  or  those  who  might  increase 
dosage;  withdrawal  symptoms  (including 
convulsions),  following  discontinuation  of 
the  drug  and  similar  to  those  seen  with 
barbiturates,  have  been  reported.  Use  of 
any  drug  In  pregnancy,  lactation,  or  in 
women  of  childbearing  age  requires  that 
its  potential  benefits  be  weighed  against  its 
possible  hazards. 

Precautions:  In  the  elderly  and  debilitated, 
and  in  children  over  six,  limit  to  smallest 
effective  dosage  (initially  10  mg  or  less 
per  day)  to  preclude  ataxia  or  oversedation, 
increasing  gradually  as  needed  and 
tolerated.  Not  recommended  in  children 
under  six.  Though  generally  not 
recommended,  if  combination  therapy 
with  other  psychotropics  seems  indicated, 
carefully  consider  individual  pharmacologic 
effects,  particularly  in  use  of  potentiating 


drugs  such  as  MAO  inhibitors  and 
phenothiazines.  Observe  usual  precautions 
in  presence  of  impaired  renal  or  hepatic 
function.  Paradoxical  reactions  (e.g., 
excitement,  stimulation  and  acute  rage) 
have  been  reported  in  psychiatric  patients 
and  hyperactive  aggressive  children. 
Employ  usual  precautions  in  treatment  of 
anxiety  states  with  evidence  of  impending 
depression;  suicidal  tendencies  may  be 
present  and  protective  measures  necessary. 
Variable  effects  on  blood  coagulation  have 
been  reported  very  rarely  in  patients 
receiving  the  drug  and  oral  anticoagulants; 
causal  relationship  has  not  been  established 
clinically. 

Adverse  Reactions:  Drowsiness,  ataxia  and 
confusion  may  occur,  especially  in  the 
elderly  and  debilitated.  These  are  reversible 
in  most  instances  by  proper  dosage 
adjustment,  but  are  also  occasionally 
observed  at  the  lower  dosage  ranges.  In  a 
few  instances  syncope  has  been  reported. 
Also  encountered  are  isolated  instances  of 
skin  eruptions,  edema,  minor  menstrual 
irregularities,  nausea  and  constipation, 
extrapyramidal  symptoms,  increased  and 
decreased  libido  — all  infrequent  and 
generally  controlled  with  dosage  reduction; 
changes  in  EEG  patterns  (low-voltage 
fast  activity)  may  appear  during  and  after 
treatment;  blood  dyscrasias  (including 
agranulocytosis),  jaundice  and  hepatic 
dysfunction  have  been  reported 
occasionally,  making  periodic  blood  counts 
and  liver  function  tests  advisable  during 
protracted  therapy. 

To  curb  anxiety 
in  the 

postcoronary  patient 


adjunctive 

Lihrium' 

(chlordiazepoxide  HCl) 

lO-mg  capsules 

Roche 

LABORATORIES 

Division  of  Hoffmann-La  Roche  Inc. 

Nutley.  New  Jersey  07110 


First  Artificial  Lysosomes  Open  New  Scientific  Frontiers 


A major  biological  breakthrough  has 
been  achieved  in  the  formation  of  the  first 
man-made  lysosomes— so  called  "suicide 
sacs"  that  trigger  the  inflammatory  process 
and  set  the  state  for  painful  and  crippling 
diseases  such  as  arthritis  and  rheumatism. 

Drs.  Gerald  Weissmann  and  Grazia  Ses- 
sa.  New  York  University  School  of  Medicine 
scientists,  believe  they  have  found  a key 
to  the  understanding  of  this  process  in  the 
"manufacture"  of  the  first  artificial  organel- 
le—a part  of  the  cell.  The  artificial  lyso- 
some,  according  to  Dr.  Weissman,  is  per- 
haps the  simplest  form  of  organelle. 

Dr.  Weissmann  reported  the  achievement 
to  colleagues  at  the  Third  Annual  Sym- 
posium of  the  International  Inflammation 
Club,  Brook  Lodge,  sponsored  by  The  Up- 
john Company.  The  investigator  told  in- 
terviewers that  the  laboratory-produced 
organelle,  capable  of  containing  and  re- 
leasing enzymes,  behaves  in  a test-tube 
environment  exactly  as  its  natural  counter- 
part, the  lysosome,  does  Tn  the  human 
body. 

Lysosomes  are  present  in  most  living 
cells.  They  contain  powerful  enzymes 
which  usually  are  protective,  but  can  be- 
come dangerously  destructive.  When  the 
host  cell  is  attacked  by  a virus  or  other 
foreign  particle,  the  invader  is  met  by  the 
lysosome,  engulfed,  and  destroyed  by  the 
enzymes.  This  process,  phagocytosis,  pro- 
tects the  body  against  disease.  When  the 
cell  is  overwhelmed  by  undigestible  mat- 


ter, injury,  or  violent  infection,  however, 
the  lysosome  releases  its  enzymes  into  sur- 
rounding tissues  by  mechanisms  which  are 
not  yet  understood.  The  enzymes  proceed 
to  destroy  other  cells  and  affect  extracellu- 
lar materials,  causing  the  pain,  swelling, 
and  other  effects  of  inflammation. 

The  artificial  lysosome— called  a lipo- 
some—is  structured  of  fatty  substances,  or 
lipids,  and  formed  in  thin  layers  similar 
to  an  onion  skin.  The  enzyme— in  this  case, 
lysozyme— is  captured  in  the  watery  inter- 
spaces between  those  layers. 

The  significance  of  this  development.  Dr. 
Weissmann  said,  is  that  it  permits  extensive 
in  vitro  study  of  the  chemical  effects  of 
drugs  and  hormones  on  lysosome  activity, 
and  particularly,  that  it  will  enable  re- 
search leading  to  control  of  the  mechanisms 
by  which  the  lysosome  acts— either  to  pro- 
tect or  destroy  its  environment. 

"The  artificial  lysosome— the  liposome— 
is  made  with  commercially  available  puri- 
fied lipids  and  enzymes,"  Dr.  Weissmann 
pointed  out.  "This  means  it  can  be  repro- 
duced in  any  laboratory  in  the  world." 

Dr.  Weissmann  said  he  now  is  working 
on  capturing  other  enzymes  within  the  ar- 
tificial organelle  and  that  "a  logical  de- 
velopment of  these  experiments  could  be 
the  formation  of  artificial  red  blood  cells." 

Details  of  the  experiments  leading  to  the 
developrrrent  of  the  artificial  lysosome  was 
published  in  the  July  10,  issue  of  The 
Journal  of  Biological  Chemistry. 


Give  Nurses  Responsibility 

But  there  is  now  too  much  for  us  to  do  alone,  and  we  must  learn  to 
delegate  some  of  our  responsibilities.  Nevertheless,  we  oppose  this  with 
countless  rationalizations.  We  think  we  will  lose  power  or  prestige,  so  we 
say  that  change  will  "weaken  the  doctor-patient  relationship."  We  refuse 
to  let  nurses  take  patient  histories  "because  the  history  is  the  most  im- 
portant part  of  the  examination;"  but  then  we  depend  heavily  on  nurses' 
notes  in  the  hospital,  never  acknowledging  to  ourselves  how  much  their 
observations  (history  and  physical-examination  findings)  contribute  to  pa- 
tient care.  In  coronary-care  units,  where  it  suits  our  convenience  and  where 
patients  are  seriously  ill,  we  give  nurses  tremendous  responsibility;  but 
we  resist  giving  them  one-tenth  that  responsibility  in  our  office  practice, 
where  they  could  help  many  more  patients.  (Len  Hughes  Andrus,  M.D.: 
The  Enemy  Is  Us,  Medical  Opinion  & Review  [Apr.]  1970,  pg.  30.) 


264 


Illinois  Medical  Journal 


Let’s  reciprocate 

(Contmued  from  page  240) 

Let  me  emphasize  that  Rock  Island  Coun- 
ty shares  the  goal  of  the  medical  profes- 
sion in  Illinois,  including  the  Illinois  Med- 
ical Examining  Committee— quality  medical 
care  for  Illinois  residents.  When  a physi- 
cian wants  to  come  to  an  Illinois  commun- 
ity and  is  given  encouragement  by  physi- 
cians in  that  community,  but  provisions 
of  the  state  law  discourage  him,  it  is  a 
blow  to  the  medical  profession  and  also 
to  the  community  which  has  been  denied 
that  physician. 

The  Reference  Committee  hearing  made 
it  clear  that  the  Illinois  Medical  Examin- 
ing Committee  has  very  broad  responsibil- 
ities, and  it  is  commendable  and  laudable 
that  the  Committee  has  been  able  to  do  all 
the  law  requires  it  to  do.  The  resolution  of 
those  seeking  to  establish  true  reciprocal 
licensing  is  in  no  manner  or  form  an  at- 
tack on  the  Committee;  it  is  a dedicated 
and  sincere  attempt  to  change  the  outdated 
system  which  requires  the  Committee  to 
operate  as  it  does. 

Medical  licensing  laws  and  examinations 
were  established  in  the  days  when  mail 
order  medical  schools  were  in  vogue  and 
an  examination  was  in  fact  necessary  to 
establish  a man’s  qualifications.  Most  were 
amended  through  the  years,  but  some  of 
the  laws  have  not  kept  pace  with  contem- 
porary times.  Certainly,  under  educational 
standards  of  the  last  20  years,  it  would  seem 
reasonable  to  grant  a reciprocal  license  to 
any  qualified  physician  who  is  a graduate 
of  any  fully  accredited  medical  school  in 
the  Lhrited  States  and  Canada,  who  has 
completed  an  internship  program  approved 
by  the  AMA  and  has  been  duly  licensed  by 
a state  or  is  a Diplomate  of  the  National 
Board  of  Medical  Examiners. 

Even  those  criteria  are  changing  w’ith  the 
internship  requirement  no  longer  neces- 
sary in  some  specialty  areas.  Certainly  li- 
censing laws  must  be  changed  to  keep  pace. 

\Ve  are  told  that  if  reciprocal  licensing 
examinations  are  eliminated  for  physicians, 
they  must  also  be  eliminated  for  chiro- 
practors, whose  representative  on  the  Illi- 
nois Medical  Examining  Committee  would 
surely  cry  discrimination.  The  law  discrim- 
inates now  in  that  physicians  are  given  one 
type  of  examination  while  chiropractors 


are  given  another.  The  law  also  discrimin- 
ates between  physicians  who  passed  the 
National  Board  Examination  prior  to  Jan- 
uary 1,  1964,  and  those  who  passed  the 
same  examination  after  January  1,  1964. 
The  law  then  should  certainly  be  able  to 
discriminate  between  physician  graduates 
of  schools  which  are  examined  and  accred- 
ited by  educational  organizations  and  gov- 
ernmental bodies  to  assure  their  education- 
al quality,  and  chiropractic  graduates  of 
institutions  which  are  accredited  by  only 
their  ow’n  trade  associations. 

If  the  above  reason  is  valid,  it  would  seem 
that  chiropractic  is  partially  to  blame  for 
the  physician  shortage  in  Illinois  because 
fear  of  chiropractic  prevents  reciprocal  li- 
censing without  examination.  It  would  also 
seem  desirable  and  necessary  for  the  appro- 
priate ISMS  committee  to  w'ork  on  separ- 
ating medical  licensure  from  chiropractic 
licensure. 

The  inclusion  of  chiropractors  under  the 
Illinois  Medical  Practice  Act  is  a sin  of 
commission  which  should  be  rectified  at 
the  earliest  opportunity.  If  quality  health 
care  is  really  what  we  are  after,  then  chiro- 
practice  should  be  outlawed  in  Illinois, 
because  chiropractors  are  not  trained  to 
diagnose  nor  to  treat  disease.  Their  inclu- 
sion in  the  Medical  Practice  Act  gives  chiro- 
practic a stature  it  does  not  deserve  and 
demeans  the  stature  of  the  medical  pro- 
fession. 

At  the  Reference  Committee  hearing  we 
were  told  that  “if  a doctor  wants  to  prac- 
tice badly  enough  in  a certain  place,  he’ll 
get  there  regardless  of  what  the  require- 
ments are.”  This  is  probably  true  of  the 
men  who  go  to  the  most  desirable  states— 
California,  Elorida  and  Arizona.  But  let 
us  acknowledge  that  Illinois  does  not  have 
the  physical  attraction  of  these  states,  and 
we  must  compete  with  them  for  practicing 
physicians  and  for  recent  graduates.  Let 
us  remember  that  we  are  not  talking  about 
those  physicians  who  know  where  they  are 
going  to  go,  but  rather  about  those  phy- 
sicians who  are  not  so  sure  and  whom  we 
are  trying  to  recruit  to  come  to  Illinois 
because  there  is  a chance  that  we  can  get 
them  here.  If  our  climate  were  similar  to 
the  above-named  states,  our  job  would  be 
easier. 

Also  cited  is  a report  of  the  AMA  De- 
partment of  Elealth  Manpower,  adopted  at 


for  September  1970 


269 


the  December,  1969  Clinical  Convention. 
The  report  tabulated  the  physician/popu- 
lation  ratio  of  13  states  and  their  reciprocal 
agreements,  and  concluded  that  interstate 
reciprocity  has  no  effect  on  the  current 
inequitable  distribution  of  physicians  in 
the  United  States.  This  must  also  imply 
that  interstate  reciprocity  has  no  effect  on 
recruiting.  The  action  of  the  1970  ISMS 
House  of  Delegates  shows  that  there  are 
many  counties  in  Illinois  who  do  not  agree 
with  this  premise.  The  Executive  Commit- 
tee of  the  Rock  Island  County  Medical  So- 
ciety exjDressed  extreme  disgust  with  this 
report,  stating  that  it  is  one  thing  to  sit 
in  an  office  and  tabulate  figures,  but  it  is 
another  to  get  out  as  a practicing  phy- 
sician and  actively  recruit.  While  it  may 
not  alter  nationwide  distribution  of  phy- 
sicians, those  of  us  who  have  been  actively 
recruiting  know  from  first-hand  experieirce 
that  lack  of  reciprocal  licensing  is  a stumb- 
ling block. 

According  to  AMA  statistics  (JAMA, 
June  15,  1970),  Illinois  ranks  fifth  behind 
California,  New  York,  Pennsylvania,  and 
Massachusetts  in  the  number  of  reciprocity 
licenses  processed  annually.  New  York  and 
Pennsylvania  issue  licenses  by  reciprocity 
or  endorsement  on  a continuous  basis; 
California  issues  on  a weekly  basis;  Mass- 
achusetts issues  weekly  except  during  the 
month  of  August.  Yet  Illinois  continues  to 
issue  them  only  on  a quarterly  basis.  The 
resolution  passed  by  the  ISMS  House  of 
Delegates  was  intended  to  eliminate  the 
long  delays  which  often  occur  in  j^rocessing 
and  cause  the  applicant  to  locate  his  prac- 
tice elsewhere. 

The  Reference  Committee  rejrort  said 
the  major  problem  is  really  lack  ol  com- 
munication between  the  licensure  appli- 
cants and  the  Medical  Examining  Com- 
mittee. While  this  may  occur  occasionally, 
information  supplied  by  the  Department 
of  Registration  and  Education  is  specific 
and  it  seems  inconceivable  that  this  could 
be  a major  cause  of  delay.  Perhaps  the 
problem  is  in  the  Department  of  Registra- 
tion and  Education  and/or  its  communica- 
tion with  the  Medical  Examining  Com- 
mittee. 

A voluminous  report  prepared  for  the 
Illinois  Board  of  Higher  Education  in 
June,  1968,  gives  a detailed  and  document- 
ed account  of  current  and  projected  health 


care  needs  in  the  state.  The  report  points 
out  that  one-third  of  the  population  sought 
physicians’  services  at  least  once  a year  30 
years  ago;  today,  two-thirds  do  so,  and  the 
percentage  will  continue  to  increase  as  af- 
fluence, education  of  the  population,  and 
private  and  government-financed  insurance 
programs  increase.  The  report  states  that 
20-25%  of  the  Illinois  population  has  no 
preventive  medical  care. 

The  critical  need  for  physicians  is  a 
problem  which  must  be  attacked  on  many 
fronts.  We  are  firndy  convinced  that  re- 
ciprocal licensing  would  be  a great  step 
forward  in  helping  to  recruit  physicians. 

The  Illinois  Medical  Examining  Com- 
mittee is  to  be  commended  for  the  work 
it  has  done  under  a difficult  situation,  but 
the  situation  should  be  corrected.  We 
wholeheartedly  agree  with  the  editorial 
opinon  expressed  by  Dr.  Erederick  T. 
Merchant  in  the  June  15,  issue  of  JAMA. 

“While  it  would  seem  justifiable  to  give 
a broad-based  examination  to  the  very  re- 
cent graduate,  it  has  become  increasingly 
clear  that  this  indeed  is  a disservice  to  the 
older  and  more  remote  graduate  who  has 
confined  himself  in  a specialty  area  and 
cannot  qualify  with  any  assurance  for  li- 
censure under  the  usual  procedures,”  Dr. 
Merchant  said. 

Speaking  of  the  need  for  change,  his 
editorial  says;  “Unfortunately  fixed  stat- 
utory provisions,  under  which  (medical 
examining)  boards  must  operate,  are  too 
often  undrdy  restrictive  or  inelastic,  even 
loo  obsolete,  to  allow  medical  boards  to 
meet  and  resolve  the  challenges  of  the 
changing  times  in  any  expeditious  or  real- 
istic manner.  It  is  paradoxical  that  state 
legislatures  which  seem  bent  at  all  costs 
to  develop  new  medical  schools  and  to  ex- 
press concern  over  medical  manpower  and 
liealth  care,  are  at  the  same  time  obdurate 
or  obstructive  at  approving  changes  or 
amendments  in  medical  practice  acts  which 
are  corollary  to  such  expansion.” 

The  time  for  change  is  here! 

We  believe  that  medical  licensure  and 
chiropractic  licensure  must  be  divorced; 
that  the  Medical  Examining  Committee’s 
activities  should  be  restricted  only  to  li- 
censure of  physicians  and  supervision  of 
already-licensed  physicians;  that  the  com- 
mittee shoidd  be  given  sufficient  economic 

(Continued  on  page  280) 


270 


Illinois  Medical  Journal 


Looking  for  a Place  to  Practice? 
Placement  Service  Lists  Openings 


In  ;m  efiort  to  reduce  the  number  of 
towns  in  Illinois  needing  practicing  physi- 
ciins,  the  Jotanal  is  publishing  synopses 
submitted  to  the  Physicians  Placement 
Service  concerning  openings  for  doctors. 

Physicians  who  are  seeking  a place  to 
practice  or  tvho  know  of  any  out-ol-state 
physicians  seeking  an  Illinois  residence  are 
asked  to  notify  the  placement  service. 

Information  and  comments  are  also  re- 
quested from  physicians  living  near  the 
communities  listed  as  to  the  real  need  and 
the  ability  of  the  town  to  support  addi- 
tional physicians. 

Inquiries  and  comments  should  be  di- 
rected to  Mrs.  Robert  Swanson,  Secretary, 
Physicians  Placement  Service,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave., 
Chicago  60601. 

Subsequent  to  the  listings  over  the  past 
30  months,  the  following  supplemental  list 
of  openings  is  furnished.  This  will  be  con- 
tinued next  month. 

BUREAU  COUNTY:  Princeton;  popula- 
tion: 6500.  Trade  area:  10,000.  Opening 
with  two  physicians  or  solo.  Eight  doctors 
here  including  4 G.P.s.  One  hundred  and 
thirty  bed  hospital.  Small  industry  and  ag- 
riculture. Protestant  and  Catholic  churches. 
Public  and  parochial  schools.  Country  club 
with  golf  course.  Sixty  miles  from  Peoria. 
New  office  ready  and  waiting.  Week-end, 
holiday  and  vacation  relief  call.  For  furth- 
er information  contact:  G.  E.  Rathbun, 
M.D.,  730  S.  Main,  Princeton. 

COOK  COUNTY:  Chicago.  Opening  for 
associate  medical  director  of  large  manu- 
facturing CO.  Prefer  general  practitioner, 
internist  or  surgeon.  For  further  informa- 
tion contact:  Carl  Von  Ammon,  Boyden 


Associates,  111  W.  Monroe,  Chicago  60603. 
Phone:  312-782-1581. 

COOK  COUNTY:  Chicago.  Field  Clinic. 
Forty-five  man  group  established  in  19 11: 
largest  private  medical  clinic  in  Cook 
County.  Opening  lor  GP  or  internist.  All 
specialties  represented  in  group.  Salary: 
S21,000.  for  GP:  S26,000  for  internist.  Op- 
portunity for  partnership  alter  two  years. 
Nea’  by  Ravenswood  hospital  expanding  to 
500  beds  in  1971,  one  block  from  clinic. 
For  further  information  contact:  Kenneth 
Hatfield,  M.D.,  4600  N.  Ravenswood  Ave., 
Cdiicago.  Phone:  312-275-7700. 

COOK  COL^NTY:  Chicago.  Opening  for 
an  associate,  GP  or  internist.  Open  imme- 
diately. Financial  arrangement  negotiable. 
Doctor  owns  building  with  pharmacy,  den- 
tist and  optometrist  as  tennants.  Near  Mt. 
Sinai  and  Evangelical  hospitals.  For  furth- 
er information  contact:  Marvin  Lerner, 
M.D.,  4900  S.  Archer  .Yve.,  Chicago.  Phone: 
312-581-7056. 

DLIPAGE  COLbNTY:  Warrenville;  popu- 
lation: 5,000.  Opening  for  GP  or  internist. 
Three  nearby  hospitals.  Per  cent  or  salary. 
Thirty  miles  west  of  Chicago.  For  further 
information  contact:  Robert  Allison,  M.D., 
^Varrenville.  Phone:  312-393-1221  or  312- 
365-6364. 

EFFINGHAM  COUNTY:  Effingham;  pop- 
nlation:  11,000.  Trade  area:  60,000.  Nine 
physicians.  St.  Anthony  hospital;  64  beds. 
Seventy  miles  from  Champaign  & Terre 
Haute,  100  miles  from  St.  Louis.  Four  drug 
stores.  Agriculture  and  industry.  Fifteen 
Protestant  and  Catholic  churches.  Six  grade 
schools  and  two  high  schools.  Three  golf 
courses,  2 indoor  pools.  Lake,  etc.  Office 
space  available.  For  further  information 
contact;  David  Lustig,  111  W.  Jefferson, 
Effingham.  Phone;  217-342-2877. 


Now  Is  It  a "Slave  Labor  Law"? 

Would  you  believe  that  workers  file  more  unfair  practice  charges  against  un- 
ions than  do  employers?  NLRB  reports  that  during  the  last  quarter  of  1969,  such 
charges  were  filed  by  860  individuals  and  728  employers  and  employer  associa- 
tions. 


for  September  1970 


27.? 


(Contijmed  from  page  20S) 

ommended  that  ECFMG  physicians  be  gi'anted  permanent  but  limited 
licenses  to  practice  in  the  State  of  Illinois  hospitals. 

The  Board  reviewed  this  matter  and  referred  it  to  the  Com- 
mittee on  Licensure  in  consultation  with  the  Council  on  Legis- 
lation, for  recommendation. 

Possible  Implementation  of  Prepayment  Plan 

The  Board  received  the  outline  of  a possible  prepayment  plan 
at  the  University  of  Illinois  Hospitals  in  conjunction  with 
IDPA,  Payments  would  be  on  a capitation  basis  rather  than  fee- 
for-service.  The  University  of  Illinois  would  provide  medical 
services  in  the  so-called  valley  area  on  Chicago’s  west  side. 
This  is  a demonstration  project  under  Medicaid  for  a medically 
deprived  area  where  there  is  little  interference  with  the  pri- 
vate practice  of  medicine.  Patients  have  the  choice  of  being 
covered  by  the  plan  or  of  receiving  their  benefits  on  the  usual 
f ee-f or-service  basis. 

Policy  on  Release  of  Hospital  Records 

The  Board  concurred  with  the  Policy  Committee  that  the  policy 
regarding  release  of  hospital  records  should  not  be  changed. 
This  policy  states  that  these  records  are  privileged  information 
and  are  the  property  of  the  patient,  maintained  in  trust  by  the 
hospital  and  are  only  to  be  released  upon  court  order.  They 
may  be  furnished  to  third  party  carriers  and  government  agencies 
in  summary  or  abstract  form  upon  written  request  by  the  patient. 
Statutes  may  require  that  records  be  released  to  allow  benefit 
payments.  However,  the  Board  recognized  that  ethics  and  law  do 
not  always  coincide  and  the  policy  should  be  maintained.  The 
in''''iolability  of  confidentiality  or  records  must  be  protected  ; 
however,  the  Board  did  recognize  that  a reasonable  request  for 
a summation  or  explanation  of  a case  should  be  honored. 

Dues  Billing  Procedure 

Upon  review  of  the  Finance  Committee’s  report,  the  Board 
resolved  to  include  the  $2  House-passed  one-time  special  assess- 
ment in  1971,  as  part  of  the  total  dues  billing.  This  will  result 
in  a billing  for  $107.  A notation  will  be  affixed  indicating 
that  $2  is  due  to  the  special  assessment  for  sending  ISMS  pub- 
lications to  SAMA  members  in  Illinois  Medical  Schools.  This 
procedure  will  be  followed  to  facilitate  automated  handling  of 
accounts. 

Meetings  Scheduled  for  Board 

The  schedule  for  future  meeting  dates  and  sites  was  approved. 
The  October  meeting  will  be  at  Augustines,  Belleville,  October 
24-25.  Other  meetings  will  be  ; 

Jan.  16-17,  1971  Blackstone  Hotel,  Chicago 
Mar.  13-14,  1971  Ambassador  Hotels,  Chicago 
May  15-19,  1971  Arlington  Park  Towers,  Arlington 
Heights 

July  17-18,  1971  O’Hare  Hyatt  House,  Rosemont 


274 


Illinois  Medical  Journal 


In  related  actions,  the  Board: 


• heard  a report  regarding  Comprehensive  Health  Plan- 
ning activities  in  Illinois  ; the  Board  voted  to  sup- 
port retention  of  this  activity  in  the  Department  of 
Public  Health  rather  than  in  the  Governor' s Office , as 
has  been  proposed;  a communication  will  be  forwarded 
to  the  Governor's  coordinator  of  health  services  to 
make  this  position  known; 

• received  an  indication  that  the  House  of  Delegates 
passed  a resolution  regarding  acceptability  of  the 
signature  of  clinic  managers  on  claim  forms,  rather 
than  requiring  physician  signatures,  is  still  under 
study  by  IDPA  ; 

• referred  proposed  changes  in  the  Bylaws  which  would 
establish  affiliate  status  for  specialty  societies, 
to  the  Committee  on  Constitution  & Bylaws  ; 

• referred  to  the  Task  Force  on  Physician  Shortage  and 
Services  to  Medically  Deprived  Areas  and  to  the  Fi- 
nance Committee  the  House  resolution  requesting  the 
establishment  of  a loan  program  for  inner-city  stu- 
dents, similar  to  the  present  Student  Loan  Program, 
funds  to  come  from  the  Task  Force  allocation; 

• instructed  the  Task  Force  on  Physician  Shortage  to 
become  a liaison  group  between  ISMS  and  interns  and 
residents  ; 

• approved  dates  for  the  1970-71,  President's  Tour,  as 
well  as  tentative  plans  for  the  program  format  ; some 
new  features  and  extension  of  hospitality  to  nurses, 
hospital  personnel  and  other  paramedical  groups,  will 
be  included  in  this  next  tour  ; sessions  on  physician' s 
liability  will  highlight  the  afternoon  sessions  ; 

• received  a report  from  the  Policy  Committee  regarding 
resolutions  70M-26,  changing  the  function  of  the  House 
of  Delegates  to  the  "state  medical  forum"  and  70M-27, 
relating  to  direct  House  action  on  ISMS  finances  ; the 
Policy  Committee  will  report  its  recommendations  di- 
rectly to  the  next  meeting  of  the  House  of  Delegates; 

• approved  the  membership,  as  nominated  by  the  Chair- 
man, of  the  ISMS  Councils  and  Committees  for  1970-71. 
Upon  notification  and  acceptance  of  appointments  the 
various  groups  will  be  constituted  and  the  full  lists 
will  be  published  in  the  IMJ  Reference  Issue,  October  ; 

• adopted  the  mid-year  budget  revision  which  consisted 
of  shifting  some  line  items  to  bring  them  into  con- 
formity with  actual  circumstances  and  performances  ; 
no  major  revisions  were  effected  and  all  totals  re- 
mained the  same  ; 

• heard  a detailed  report  on  specific  programs  and  ac- 
complishments of  the  Health  Careers  Council  of  Illi- 
nois, by  its  Executive  Director  Donald  Frey;  he  ex- 
plained budgets,  funding,  staffing  and  related  mat- 
ters ; 

• authorized  staff  to  explore  the  feasibility  of  a 
state-wide  council  on  homemaker ' s services,  to  assist 
in  developing  the  program  and  gaining  stability; 

• heard  a report  by  Dr.  Breed  on  the  results  of  a survey 


for  September  1970 


275 


of  students,  residents  and  interns,  to  determine 
plans  for  type  and  place  of  practice  ; the  results  will 
be  serialized  in  the  IMJ  ; 

• reviewed  with  the  AMA  Delegation  chairman  the  results 
of  Illinois  presented  resolutions  to  the  AMA,  as  well 
as  other  concerns  of  the  delegation; 

• approved  competitive  bidding  for  the  IMJ  and  “Pulse” 
printing,  and  maintenance  of  1970  advertising  rates 
in  1971;  in  addition  heard  of  possible  savings  by  se- 
lective elimination  of  certain  reference  issue  items  ; 
the  Board  also  authorized  the  Publications  Committee 
to  communicate  directly  with  the  Committee  on  Labora- 
tory Services  regarding  possible  advertising  by  auto- 
mated laboratories ; 

• expressed  its  appreciation  and  congratulations  to 
Dr.  V.  P.  Siegel  for  his  work  on  the  Council  on  Legis- 
lation and  Public  Affairs; 

• the  Board  received  reports  from  the  officers  and  trus- 
tees for  information;  no  specific  actions  were  called 
for. 


Approvals  and  Appointments; 

Dr.  Jack  Gibbs,  of  Canton,  was  appointed  the  official  ISMS 
representative  to  the  October  22-24,  AMA  National  Congress  on 
Health  Manpower , Chicago; 

Dr.  J.  Ernest  Breed  will  attend  the  Fourth  World  Conference 
on  General  Practice,  August  12-15,  Chicago; 

The  Board  recommended  for  possible  appointment  to  AMA,  Com- 
mittee on  Transfusion  and  Transplantation,  Dr.  James  Hartney  of 
Oak  Park  and  Dr.  Louis  R.  Limarzi,  Chicago  ; Committee  on  Trans- 
fusion and  transplantation; 

Dr.  Harold  C.  Lueth  of  Evanston,  was  recommended  for  appoint- 
ment to  the  AMA  Council  on  National  Security; 

Dr.  Edward  W.  Cannady  of  East  St.  Louis,  was  named  as  a member 
of  the  Nomination  Committee  of  IRMP ; 

Dr.  William  E.  Adams  of  Chicago,  was  reappointed  to  the  Gov- 
erning Board  of  the  Midwest  Regional  Health  Science  Library; 

The  AMA  Delegation  has  presented  the  names  of  the  following 
physicians  to  be  considered  for  appointment  to  the  AMA  Committee 
on  Long  Range  Planning  and  Development:  Drs.  Philip  G.  Thomsen, 
Harlan  English,  Warren  Tuttle  and  Fredric  D.  Lake. 


Research  and  training  grants  accepted 
by  U.  of  /.  at  Medical  Center 

The  University  of  Illinois  Medical  Center  Campus  ac- 
cepted an  overall  total  of  $367,298  in  research  and  training 
grants  for  the  month  of  July.  Out  of  16  grants  listed,  6 
grants  totaling  $226,230  were  from  the  United  States 
Public  Health  Service. 

The  funds  were  allocated  as  follows:  $25,851,  College 
of  Dentistry;  and  $341,447,  College  of  Medicine. 

The  largest  single  grant,  $60,376,  was  awarded  to 
Dr.  Neena  B.  Schwartz,  professor  of  physiology  College 
of  Medicine,  by  the  United  States  Public  Health  Service  for 
the  project  entitled  "Environmental  and  Hormonal  Interplay 
of  Ovulation." 


276 


Illinois  Medical  Journal 


Pollens  and  molds 

(Continued  from  page  225) 
ground  fog.  Thunderstorms  are  a particular 
menace.  Favorable  conditions  occur  with 
unstable  air  when  the  weather  has  been 
cold  with  little  wind  associated  with  low 
clouds  or  smoke  at  night.  Best  of  all  in 
Milwaukee,  is  a northeast  wind  which 
blows  cleaner  air  from  the  north  over  the 
Great  Lakes. 

We  have  previously  called  attention  to 
the  possibility  of  minimizing  the  fallout  of 
radioactive  particles  by  means  of  smoke 
clouds  and  by  increasing  the  temperature 
of  a city  in  order  to  keep  the  air  unstable. 

◄ 

References 

1.  Heise,  H.  A.,  and  Heise,  E.  R.,  “Influence  of 
Temperature  Variations  and  Winds  Aloft  on 
Distribution  of  Pollens  and  Molds  in  Upper 
Atmosphere,”  ].  Allerg.,  20:378-382,  (Sept.),  1949. 

2.  Heise,  H.  A.,  and  Heise,  E.  R.,  “Distribution  of 
Ragweed  Pollen  and  Alternaria  Spores  in  Upper 
Atmosphere,  J.  Allerg.,  19:403-407,  (Nov.),  1948. 

3.  Heise,  H.  A.  and  Heise,  E.  R.,  “Meteorologic 
Eacters  in  Distribution  of  Pollens  and  Molds,” 
Ann.  Allerg.,  8:641-644  - 681,  (Sept.-Oct.),  1950. 

4.  Heise,  H.  A.,  and  Heise,  E.  R.,  “Effect  of  a City 
on  the  Eall-out  of  Pollens  and  Molds,”  J.A.M.A., 
163  (March  9),  1957. 

Private  hospital 

(Continued  from  page  238) 
should  be  developed  to  its  highest  calibre 
and  permit  the  residents  and  interns  an 
opportunity  to  experience  and  meet  an  ex- 
cellent calibre  of  the  teaching.  This  is  par- 
ticularly relevant  in  the  teaching  of  foreign 
interns  and  residents.  The  preceptorship 
system  may  be  applicable,  and  may  be  most 
helpful  to  the  foreign  medical  graduate 
initially  entering  a stateside  program. 

Summary 

The  private  non-affiliated  metropolitan 
community  hospital  has  a committment  to 
be  an  integial  part  of  the  local  community. 
Its  prime  function  is  to  give  service.  To 
maintain  a high  calibre  of  service,  there 
should  be  considered  the  advisability  of  de- 
veloping a secondary  function  of  post- 
graduate medical  education.  Some  of  the 
advantages  and  disadvantages,  solutions 
and  problems,  philosophical  and  pragmatic 
aspects  related  to  residency  and  intern 
training  programs  have  been  discussed.  M 

Do  You  Know? 

There  are  100  taxes  on  an  egg,  150  on 
a woman’s  hat,  151  on  a loaf  of  bread  and 
600  on  a house? 


Z^ctiruiew 

Dedicated  to  Progressive  Psychiatry 
and  Oriented  to  Short  Term 
Hospitalization  and  Treatment 


"MAN  IS  NOT  SOUL  OR  BODY,  BUT  THESE 
TWO  SUBSTANCES  INMOSTLY  UNITED" 


Psychological  and  Physiological  ther- 
apies for  the  neuroses,  psychoses  and 
psychosomatic  disorders,  with  special 
emphasis  on  INSULIN  DEEP  COMA 
THERAPY  for  the  schizophrenias  and 
the  newly  developed  INDOKLON 
THERAPY  for  the  depressions. 

FOR  ADOLESCENTS:  Quality  care  with 
specialized  programs  including  ac- 
credited schooling. 

Phone:  312-878-9700 
4840  NORTH  MARINE  DRIVE 
CHICAGO,  ILLINOIS  60640 

J.  Dennis  Freund,  M.D.,  Medical  Director 


for  September  1970 


277 


You  Are  Invited  To: 

ILLINOIS  PSYCHIATRIC  SOCIETY 

Down-State  Fall  Meeting 
Champaign- Urbana,  Illinois 
September  25-26-1970 

Friday,  September  25 

1:00  p.m.— REGISTRATION— Ramada  Inn,  Champaign, 
Illinois 

3:00  p.m.-SIMULTANEOUS  SESSlONS-(l)  "General 
Hospital  Psychiatry,"  Mercy  Hospital,  Urbana,  Illi- 
nois 

Panel  Members:  Howard  Nelson,  M.D.,  Rudolph  No- 
vick,  M.D.,  Harry  Little,  M.D. 

(2)  "Childrens'  Disorders,"  Childrens'  Research  Cen- 
ter, University  of  Illinois,  Urbana,  Illinois,  Robert 
Sprague,  Ph.  D.  & Staff 

7:00  p.m.— DINNER  MEETING— Ramada  Inn,  Cham- 

paign, Illinois,  Dinner  Speaker:  ALBERT  J.  GLASS, 
M.D.,  Director,  Illinois  Department  of  Mental 
Health 

Saturday,  September  26 

9:00  a.m.-THREE  SIMULTANEOUS  PANELS-at  Rama- 
da Inn— Champaign 

(1)  "Drug  Abuse" 

John  M,  Chappel,  M.D.  et.  al. 

(2)  "Student  Mental  Health" 

Theodore  Klersch,  M.D.,  John  E.  Kysar,  M.D., 
Robert  Chapman,  M.D. 

(3)  "Psycho- Pharmacology— Refresher  Course" 

Jan  Fawcett,  M.D. 

1:00  p.m.-ILLINOIS-TULANE  FOOTBALL  GAME 

(Tickets  for  reserved  seats  to  be  sold— "first  come 
—first  served") 

ADDRESS:  Dr.  Lewis  Kurke.  Program  Committee 
Illinois  Psychiatric  Society 
Adolf  Meyer  Center 
Decatur,  Illinois  62526 

COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 
STARTING  DATES— 1970 

SPECIALTY  REVIEW  COURSE  IN  MEDICINE,  Part  1,  Sept. 
14  & 21 

SPECIALTY  REVIEW  COURSE  IN  THORACIC  SURGERY,  Sept.  21 
SPECIALTY  REVIEW  COURSE  IN  UROLOGY,  Three  Days,  Oct.  14 
SPECIALTY  REVIEW  COURSE  IN  OB/GYN,  October  19 
SPECIALTY  REVIEW  COURSE  IN  SURGERY,  Part  1,  October  19 
SURGERY  OF  HEAD  AND  NECK,  One  Week,  September  21 
SURGERY  OF  STOMACH  & DUODENUM,  One  Week,  Sept.  28 
MANAGEMENT  OF  COMMON  FRACTURES,  One  Week,  Oct.  26 
AMPUTATION  SURGERY  & REHABILITATION,  2'/2  Days,  Oct. 
22 

RHEUMATOLOGY,  One  Week,  October  19 
VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  Oct.  5 
ADVANCES  IN  GYNECOLOGY  & OBSTETRICS,  One  Week, 
Sept.  28 

PEDIATRIC  SURGERY.  One  Week,  September  28 
BASIC  ELECTROCARDIOGRAPHY,  One  Week,  October  5 
BASIC  INTERNAL  MEDICINE,  One  Week,  October  12 
DERMATOLOGY,  One  Week,  October  5 
DIAGNOSTIC  RADIOLOGY,  One  Week,  September  21 
RADIOISOTOPES,  One  or  Two  Weeks,  Request  Dates 
INHALATION  & REGIONAL  ANESTHESIA,  Request  Dates 

Information  concerning  numerous  other 
continuation  courses  available  upon  request, 

TEACHING  FACULTY 

Attending  Staflf  of 
Cook  County  Hospital 

Address; 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 

THE  VIEW  BOX 

(Continued  from  page  223) 

Diagnosis:  3.  Non-functioning  left  half  of 
a horseshoe  kidney 

Horseshoe  kidney  is  the  most  frequent 
type  of  contralateral  fusion.  It  occurs  in 
approximately  one  in  four  hundred  autop- 
sies and  most  commonly  in  the  male.  In 
over  90%  of  cases,  fusion  occurs  at  the 
lower  pole.  The  kidneys  tend  to  ectopic 
in  position,  mostly  low  lumbar  or  pelvic. 
The  vascular  system  may  arise  from  unusual 
sites.  The  diagnosis  is  suggestive  on  the 
initial  IVP  in  that  the  visualized  portion 
of  the  kidney  is  seen  to  cross  the  midline 
at  the  level  of  L^,  indicating  that  there 
probably  is  another  portion  of  a horseshoe 
kidney  which  is  not  visualized  on  the  left. 
The  axis  of  the  right  side  of  the  kidney 
is  rotated.  The  abdominal  aortogram  re- 
veals an  extremely  tiny  branch  of  the  left 
renal  artery  which  is  displaced  around  hy- 
dronephrotic  sacs.  The  delayed  nephro- 
gram demonstrates  the  crossing  of  the  lower 
pole  of  the  right  side  of  the  kidney  and 
delayed  faint  filling  of  hydronephrotic  sac. 
The  recognition  of  this  condition  is  help- 
ful in  a proper  surgical  approach,  as  the 
urologist  woidd  benefit  from  the  knowl- 
edge  of  the  presence  of  a horseshoe  kidney 
by  utilizing  an  incision  which  could  get 
him  closer  to  the  midline  for  the  separation 
of  the  lower  pole. 


Film  Revieiv 

"Endoscopic  Techniques  in  Gynecology 
and  Infertility,"  outlines  the  use  of  culdo- 
scopy  and  laparoscopy  procedures  in  diag- 
nosing and  treating  gynecological  condi- 
tions. 

The  film  is  available  through  Wyeth  Lab- 
oratories sales  representatives  for  showing 
to  physicians  in  private  practice  and  hos- 
pitals, and  at  medical  society  meetings. 
The  27  minute,  16  mm,  color  film  can  also 
be  obtained  on  loan  from  the  Wyeth  Film 
Library,  Box  8299,  Philadelphia,  Pa.  19101. 


Veterans  who  drew  compensation  for 
service-connected  disabilities  rated  50  per 
cent  or  more  are  entitled  to  additional  pay- 
ments for  their  dependents,  according  to 
the  Veterans  Administration. 


278 


Illinois  Medical  Journal 


FOREST  HOSPITAL  POSTGRADUATE  CENTER 
IN  COLLABORATION  WITH 
NORTHWESTERN  UNIVERSITY 

AND 

THE  DEPARTMENT  OF  MENTAL  HEALTH,  STATE  OF  ILLINOIS 

PRESENT  THE 

ECLECTIC  CONFERENCE 

^'A  REVIEW  AND  RE-INTEGRATION  OF  PSYCHIATRIC  THERAPIES" 

November  5-8,  1970 

at 

FOREST  HOSPITAL 

Des  Plaines,  Illinois 

An  international  meeting  providing  a panoramic  viev/  of  psychiatric  tech- 
niques being  utilized  by  psychiatrists  in  both  hemispheres.  The  presentation  on 
special  therapeutic  ideas  and  practices  v/ill  be  supplemented  by  written  ab- 
stracts, "live"  case  histories,  films  and  videotapes. 

CO-CHAIRMEN:  Jules  Masserman,  M.D.,  Mortimer  D.  Gross,  M.D.,  Albert  Glass, 
M.D. 

RESERVATIONS:  Actual  cost  of  the  Eclectic  Conference  is  $155  per  regis- 
trant. The  Forest  Hospital  Foundation  and  the  State  of  Illinois  are  underwriting 
the  cost  of  $100  per  person.  Reservations  are  $55  per  person,  including  lunch- 
eons and  cocktail-theatre  party.  Only  the  first  125  reservations  can  be  accepted. 

For  Additional  Information: 

FOREST  HOSPITAL 

555  Wilson  Lane 
Des  Plaines,  Illinois  60016 
312:  827-8811 


ANOTHER  ISMS 

MEMBERSHIP  PRIVILEGE 

LOW  COST 

GROUP  INSURANCE 

GROUP 

DISABILITY  PLAN 

• NEW— Guaranteed  renewable 
feature 

• Sickness  benefits  to  age  65 

• Up  to  $250.00  weekly  benefits 


(PROTECT  YOUR  INCOME  AND  SECURITY) 


FOR  INFORMATION,  ASSISTANCE  & DETAILS 

Administrators: 


E ST^BLIS  HE  D I 9 O I 


X group  \ 

J SUPER  MAJOR  MEDICAL  PLAN  [ 

I • Up  to  $50.00  daily  room  and  board 

_ I 

^ • Up  to  $25,000  for  each  accident 
: ^ or  sickness 

• In  hospital  and  out  of  hospital 
^ . expenses 

(TRULY  CATASTROPHIC  PROTECTION) 


9933  N.  Lawler  Avenue 
Skokie,  Illinois  60076 
Phone:  312-679-1000 


for  September  1970 


279 


Dicarbosil 

ANTACID 

Your  ulcer  patients  and 
others  will  appreciate  it. 
Specify  DICARBOSIL  144  s- 
144  tablets  in  1 2 rolls. 


ARCH  LABORATORIES 

319  South  Fourth  Street,  St.  Louis,  Missouri  63102 


Classified  Advertising  Rates 


30  words  or  less—  1 insertion  $ 5.00 

3 insertions  1 12.00 

6 insertions  $18.00 

12  insertions  $30.00 

30  to  50  words—  1 insertion  $ 8.00 

3 insertions  $14.00 

6 insertions  .$24.00 

12  insertions  $40.00 


A charge  of  25^  is  made  if  replies  are  sent 
to  a box  numljer  in  care  of  the  journal. 

Cash  with  order.  No  general  advertising 
accepted  in  classified  column. 

All  copy  must  be  typewritten  on  letterhead 
or  business  stationery  of  the  advertiser.  In- 
structions must  state  number  of  insertions, 
including  time  of  first  insertion.  In  the  ab- 
sence of  this  information,  advertisements  will 
be  billed  at  the  time  of  the  first  insertion, 
(when  the  ad  appears  for  the  first  time). 

Deadline  for  classified  copy  is  the  20th 
of  month  preceding  publication  date.  For 
example:  copy  for  an  ad  scheduled  for  Sep- 
tember issue,  must  be  in  hands  of  publisher 
not  later  than  August  20.  Publication  date 
is  15th  of  each  month.  Copy  received  after 
deadline  will  be  processed  for  following  issue 
unless  advertiser  advises  otherwise.  Send  all 
copy  attention  advertising  department,  Illi- 
nois Medical  Journal,  360  N.  Michigan  Ave., 
Chicago  60601— Suite  2010. 


Obituaries 

^Arthur  K.  Baldwin,  Carrollton,  died  June 

26  at  the  age  of  81.  He  was  a member  of 
the  ISMS  Fifty-Year  Club,  past  president 
and  past  secretary  of  the  Greene  County 
Medical  Society.  He  was  selected  Outstand- 
ing General  Practitioner  of  Illinois  in  1958. 
*Hallard  Beard,  Glen  Ellyn,  died  July  25 
at  the  age  of  78.  He  was  a memer  of  the 
ISMS  Fifty-Year  Club. 

* William  J.  Cassel,  Jr.,  Springfield,  died 
July  14  at  the  age  of  51.  He  was  chief  of 
the  bureau  of  chronic  illnesses  of  the  Il- 
linois Department  of  Public  Health. 

* Chester  C.  Doherty,  Clay  City,  died  July 
22  at  the  age  of  76. 

^Joseph  S.  Drabanski,  Fox  River  Grove, 
died  August  8 at  the  age  of  63. 

Dimitri  Gostimirovich,  Carbondale,  died 
July  3 at  the  age  of  70.  He  was  chief  of 
laboratory  services  at  the  VA  hospital  in 
Marion. 

Moses  A.  Jacobson,  Waukegan,  died  Au- 
gust 1 at  the  age  of  74. 

*George  Koptik,  Sr.,  Cicero,  died  July  25 
at  the  age  of  78.  He  was  a member  of  the 
ISMS  Fifty-Year  Club. 

*Henry  Lescher,  River  Forest,  died  July 
31  at  the  age  of  76.  He  was  a member  of 
the  ISMS  Fifty-Year  Club. 

"'George  Panczyszyn,  Glenview,  died  July 
21  at  the  age  of  45.  He  died  while  vaca- 
tioning in  Florida. 

"'William  Reilly,  Chicago,  died  July  4 at 
the  age  of  75. 

"'Umberto  Savaglio,  Chicago,  died  July 

27  at  the  age  of  57. 

•’'Otto  H.  Schulz,  Chicago,  died  July  1 at 
the  age  of  89.  He  was  a member  of  the 
ISMS  Fifty-Year  Club. 

*Indicates  member  of  the  Illinois  State  Medical 
Society. 


Let’s  reciprocate 

(Continued  (rum  page  270) 

support  and  personnel  to  fulfill  its  func- 
tion; and  that  the  size  of  the  committee 
should  be  increased  as  necessary  to  fulfill 
its  function. 

We  trust  that  the  appropriate  ISMS  com- 
mittees will  heed  the  majority  of  the  House 
of  Delegates  and  move  with  all  deliberate 
speed  to  make  true  reciprocal  licensing  a 
reality.  ◄ 


280 


Illinois  Medical  Journal 


Illinois  Medical  Journal 


volume  138,  number  4 


October,  1970 


Editor  

Managing  Editor  

Editorial  Assistant  

Advertising  Manager 
Executive  Administrator 


Theodore  R.  Van  Dellen,  M.D. 

Richard  A.  Ott 

Michaelyn  Sloan 

John  A.  Kinney 

Roger  N.  White 


CONTENTS 


ANNUAL  REFERENCE  ISSUE 


ILLINOIS  STATE 
MEDICAL  SOCIETY 


(Index  to  Reference  Issue  page  444) 


360  N.  Michigan  Ave.,  Chicago,  60601 
OFFICERS 


ISMS  ORGANIZATION  . 

Principles  of  Medical  Ethics 
Constitution  & Bylaws  


I J.  Ernest  Breed,  President 

55  East  Washington  Street,  Chicago  60602 
L.  T.  Fruin,  President-Elect 
, 5 Citizen's  Square,  Normal,  61761 

George  C.  Shropshear,  1st  Vice-President 
1525  East  53rd  Street,  Chicago,  60615 
C.  J.  Jannings,  III,  2nd  Vice-President 
101  East  Center  Street,  Fairfield,  62837 
Jacob  E.  Reisch,  Secretary-Treasurer 

1129  South  2nd  Street,  Springfield  62704 
Paul  W.  Sunderland,  Speaker 

214  North  Sangamon  St.,  Gibson  City,  60936 
Andrew  J.  Brislen,  Vice-Speaker 
I 6060  South  Drexel  Blvd.,  Chicago  60637 
Willard  C.  Scrivner,  Chairman  of  the  Board 
4601  State  Street,  East  St.  Louis,  62205 


TRUSTEES 

Joseph  L.  Bordenave,  1st  District  (1971) 

1665  South  Street,  Geneva,  60134 
William  A.  McNichols,  Jr.,  2nd  District  (1971) 
101  West  First  Street,  Dixon,  61021 
Fredric  D.  Lake,  3rd  District  (1972) 

1041  Michigan  Avenue,  Evanston,  60202 
James  B.  Hartney,  3rd  District  (1973) 

410  Lake  Street,  Oak  Park,  60302 
Frank  J.  Jirka,  3rd  District  (1971) 

1507  Keystone  Ave.,  River  Forest,  60305 
William  M.  Lees,  3rd  District  (1971) 

6518  N.  Nokomis,  Lincolnwood,  60646 
Frederick  E.  Weiss,  3rd  District  (1973) 

15643  Lincoln  Avenue,  Harvey,  60426 
Warren  W.  Young,  3rd  District  (1972) 

10816  Parnell  Avenue,  Chicago,  60628 
Fred  Z.  White,  4th  District  (1973) 

723  North  Second  St.,  Chillicothe,  61523 
A.  Edward  Livingston.  5th  District  (1973) 

219  North  Main,  Bloomington,  61701 
J.  Mather  Pfeiffenberger,  6 District  (1972) 

State  & Wall  Streets,  Alton,  62002 
Arthur  F.  Goodyear,  7th  District  (1973) 

142  East  Prairie  Avenue,  Decatur,  62523 
Eugene  P.  Johnson,  8th  District  (1973) 

22  West  Main  Street,  Casey,  62420 
Charles  K.  Wells,  9th  District  (1972) 

117  North  10th  Street,  Mt.  Vernon,  62864 
Willard  C.  Scrivner,  10th  District  (1972) 

4601  State  Street,  East  St.  Louis,  62205 
Joseph  R.  O'Donnell,  11th  District  (1971) 

444  Park,  Glen  Ellyn,  60137 
Edward  W.  Cannady,  Trustee-at-Large 
4601  State  Street,  East  St.  Louis,  62205 


Microfilm  copies  of  current  as  well  as  some  back 
issues  of  the  Illinois  Medical  Journal  may  be 
purchased  from  Xerox  University  Microfilms,  300 
N.  Zeeb  Road.  Ann  Arbor.  Mich.,  48106. 


{Judex  to  Constitution  dr  Bylaws  page  341) 

Policy  Manual  

(Index  to  Policy  Manual  page  348) 

Officers  of  County  Medical  Societies  

Trustee  District  Committees  

Councils  and  Committees  of  ISMS  

(Index  to  Committees  page  380) 

ISMS  SERVICES 

Divisions  

Scientific  Speakers  Bureau  

Physicians  Placement  and  Student  Loan  Fund 

Insurance  Programs  

Professional  Liability  Program  

ILLINOIS  MEDICAL  POLITICAL  ACTION  COMMITTEE  

WOMAN'S  AUXILIARY  TO  THE  ISMS  

ILLINOIS  MEDICAL  ASSISTANTS  ASSOCIATION  

MEDICAL  AND  PARAMEDICAL  EDUCATION  

ILLINOIS  STATE  GOVERNMENT  

Departments  

Hospitals,  Laboratories  and  Centers  

MEDICAL  LEGAL  INFORMATION  

GENERAL  HEALTH  SERVICES  INFORMATION  

FEATURES 

Blue  Shield  Report  

The  President’s  Page 

Membership  Forum  

Meeting  Memos  

Lditorials -- 

Socio-Lconomic  News  

Illinois  Medical  Assistants  Association  

The  Doctor’s  Library  

New  Pharmaceutical  Specialties  

Clinics  for  Crippled  Children  

Obituaries  

(Cover  story  on  page  312) 


.323 

326 

327 


.342 

.351 

.358 

361 


.381 

.385 

.385 

.387 

.388 

.390 

390 

-393 

394 

.401 

.403 

.421 

.436 

.442 


.285 

-297 

.298 

.448 

.450 

.451 

.452 

.455 

456 

.459 

.464 


Published  monthly  by  the  Illinois  State  Medical 
Society,  360  N.  Jlichigan  Ave.,  Chicago,  111.,  60601. 
Copyright  1970.  The  Illinois  State  Medical  Society. 

Subscription  $5.00  per  year,  in  advance,  postage 
prepaid,  for  the  United  States,  Cuba,  Puerto  Rico. 
Philippine  Islands  and  Mexico.  $7.50  per  year  for 
all  foreign  countries  included  in  the  Universal  Postal 
Union.  Canada  $5.50  U.S.  Single  current  copies 
available  at  75c. 

Second  class  postage  paid  at  Chicago.  111.  and  at 
additional  mailing  offices.  When  moving  please  notify 


Journal  office  of  new  address  including  old  mailing 
label  with  notification,  if  possible.  POSTMASTER: 
Send  notice  on  form  No.  3579  to  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave.,  Chicago, 
111.  60601. 

Pharmaceutical  advertising  must  be  approved  by 
the  ISMS  Publications  Committee.  Other  advertising 
accepted  after  review  by  Publications  Committee  or 
Board  of  'Trustees.  All  copy  or  plates  must  reach  the 
Journal  office  by  the  fifteenth  of  the  month  preceding 
publication.  Rates  furnished  upon  request. 


Original  articles  will  be  considered  for  publication 
with  the  understanding  that  they  are  contributed  only 
to  the  Illinois  Medical  Journal.  The  ISMS  denies 
responsibility  for  opinions  and  statements  expressed  by 
authors  or  in  excerpts,  other  than  editorial  or  allied 
views  or  statements  which  reflect  the  authoritative 
action  of  the  ISMS  or  of  reports  on  official  actions, 
policies  or  positions.  Views  expressed  by  authors  do 
not  necessarily  represent  those  of  the  Society;  any 
connection  with  official  policies  Is  coincidental. 


ior  October,  1970 


289 


When  irritable  colon  feels  like  this 


The  blowfish,  a small  species 
of  fish,  reacts  to  stress  or 
fright  by  i)uffing  itself  up  with 
air.  Alter  about  a dozen 
noisy  gulps  the  belly  is  balloon- 
shaped and  hard.  When 
replaced  in  the  water  the  air  is 
quickly  expelled,  and 
the  fish  sinks  to  the  bottom. 


BLUE  SHIELD 


LI\ 


FOR 


NABSP  President  Notes  1969  Growth 


In  the  1969  annual  report,  John  W.  Castellucci, 
National  Association  of  Blue  Shield  Plans  president, 
noted  that  membership  in  the  74  Blue  Shield  Plans 
in  the  United  States,  Puerto  Rico  and  Moncton, 
New  Brunswick,  increased  by  over  2.6  million  per- 
sons during  1969. 

This  increase  of  4.38  percent  over  1968  brought 
total  enrollment  to  63.4  million  or  31.25  percent  of 
the  population  in  the  United  States. 

Blue  Shield  also  provides  services,  under  various 
government  programs,  for  an  additional  16.1  million 
persons. 

During  1969,  Blue  Shield  paid  out  a total  of  $1.9 
billion  in  benefits  on  behalf  of  its  subscribers,  up 
from  $1.7  billion  the  previous  year.  Benefits  paid 
out  for  individuals  served  under  government  pro- 
grams totaled  another  $1.6  billion. 

Castellucci  cited  many  innovations  during  the 
past  year.  Among  these  were: 

— Five  million  federal  employees  and  members  of 

their  families  are  now  covered  under  Blue 


If  You  Move 

Let  Us  Know 

Incorrect  addresses  on  physicians’  bills  are  one 
of  the  major  causes  of  delay  in  the  processing  of 
claims.  Many  offices  have  been  using  stationery  with 
the  old  address  when  itemizing  bills  for  benefici- 
aries. 

To  avoid  these  delays,  please  notify  Blue  Shield 
in  writing  of  the  address  change.  When  writing, 
include  the  new  and  the  old  address. 

Let  us  know,  too,  if  you  open  a second  office. 
This  will  help  us  to  speed  payments  to  you  or  to 
your  patient. 

These  notices  can  be  sent  to: 

Professional  Relations  Department 
222  North  Dearborn  Street 
Chicago,  Illinois  60690 


Shield  and  Blue  Cross  FEP  programs,  making 
this  the  largest  underwritten  group  in  existence. 
— The  British  United  Provident  Association,  with 
1.5  million  members  has  become  an  affiliate  of 
NABSP. 

— Blue  Shield  and  Blue  Cross  have  been  working 
with  local  Plans  to  establish  ongoing  long-range 
systems  procedures. 

— Blue  Shield’s  series  of  public  information  films  on 
drug  abuse  were  seen  on  television  last  year  in 
over  100  cities  across  the  nation,  and  two  million 
copies  of  the  drug  abuse  booklet  were  distributed. 

Former  SSA  Official 
Protests  NHI 

In  a speech  before  the  annual  convention  of  the 
Oklahoma  State  Medical  Association  this  spring, 
Robert  J.  Myers,  former  Chief  Actuary  of  the  So- 
cial Security  Administration,  protested  actions  of 
those  within  SSA  who  are  advocating  a national 
health  program. 

Speaking  just  nine  days  before  his  resignation 
was  accepted,  Myers  said  these  “social  planners” 
use  as  their  argument  “the  recent  large  increases  in 
medical  care  costs.” 

He  said  they  unfairly  blame  physicians  for 
“sharply  rising  medical  costs,  when  instead  these 
are  much  more  due  to  the  rising  general  price  and 
wage  level  and  to  the  trend  of  hospital  costs. 

“If  physicians  had  artifically  held  down  their  fees 
for  Medicare  patients,  these  men  would  no  doubt 
have  pointed  out  that  Medicare  was  operating  so 
well  at  low  costs,  that  it  should  be  extended  to  the 
entire  population,”  Myers  added.  “You  can’t  win.” 
Myers  said  that  he  was  convinced  that  “the  recent 
trend  in  physicians’  fees  is  entirely  justifiable  in  rela- 
tion to  other  prices  and  to  salary  levels  in  general.” 
He  criticized  former  Secretary  Cohen  for  freezing 
physicians’  fees  for  Medicare  purposes.  “These  do 
not  seem  to  me  to  be  in  accordance  with  the  intent 
of  the  law.” 


(This  is  not  an  advertisement) 


ASK  BLUE  SHIELD 


• • • ABOUT  MEDICARE 

SSA  Makes  Changes 
in  Lab  Certification 

The  Social  Security  Administration  no  longer 
considers  the  following  laboratories  certified  for 
Medicare  participation: 

Kenilworth  Laboratories 
6905  West  Cermak  Road 
Berwyn,  Illinois  60402 

Mart  X-ray  Laboratory 
7-110  Merchandise  Mart 
Chicago,  Illinois  60654 

Suburban  Laboratories,  Inc. 

2137  South  Lombard  Avenue 
Cicero,  Illinois  60650 


Information  Needed 
on  Certifications 

Though  physicians  are  usually  concerned  with 
Part  “B”  (medical)  of  Medicare,  a knowledge  of 
Part  “A”  (hospital)  benefits  has  become  important 
since  Utilization  Review  Committees  have  been  in 
operation. 

When  reviewing  the  diagnosis  and  certification 
in  order  to  provide  Medicare  benefits,  you  should 
keep  in  mind  that  while  the  certification  does  not 
have  to  be  on  any  special  form,  it  must  contain  the 
following  information: 

1.  Reason  for  continued  care.  (A  diagnosis  alone 
is  not  acceptable.) 

2.  Estimated  length  of  stay. 

3.  Plans  for  post  hospital  care. 

4.  It  must  be  signed  and  dated.  (Failure  to  date 
it  would  make  the  certification  invalid.) 

Also  keep  in  mind  that  you  may  certify  prior  to 
the  twelfth  day,  but  if  you  sign  after  the  twelfth 
day,  a reason  for  the  delay  must  be  given.  Other- 
wise, no  benefits  can  be  paid. 


Should  Hit  Peak  in  1972  Election 

PRESSURE  BUILDING  UP  OVER 
NATIONAL  HEALTH  INSURANCE 


The  battle  for  National  Health  Insurance  didn’t 
just  begin.  It’s  been  going  on  since  1916,  and  was 
a national  issue  as  far  back  as  the  Wagner  Bill  in 
1939.  Some  of  the  present  proponents  of  NHI  have 
been  working  hard  for  it  since  the  early  1930’s. 

In  1959,  proponents  of  NHI  changed  tactics  and 
decided  to  settle  for  a national  health  program  for 
those  over  65  as  a temporary  compromise.  From 
1959  until  1965  they  fought  for  Medicare.  From 
1965  until  recently,  attention  was  on  making  Medi- 
care work.  But  now  that  Medicare  is  working  pretty 
well,  the  proponents  of  NHI  feel  their  final  ob- 
jective is  within  reach. 

If  they  run  into  stiflF  opposition,  however,  pro- 
ponents might  offer  this  compromise — make  Medi- 
care benefits  broader,  drop  deductibles  and  coin- 
surance, and  extend  Medicare  to  the  disabled  and  to 
children  under  .18.  Presumably,  this  would  be  an 
interim  goal,  as  was  Medicare  itself. 

The  proposals  being  developed  will  probably  run 
along  these  lines. 

Group  One — Private  insurance  approach  with 
federal  government  helping  either  the  poor  or  every- 
one to  purchase  a minimum  standard  program 
through  tax  credits.  Leading  this  group  is  the  AMA. 

Groujp  Two — Medicare  or  Medicaid  type  ap- 
proach administered  by  the  federal  government 


(Social  Security  Administration  or  a new  agency) 
or  state  agencies,  with  option  to  use  private  car- 
riers. This  concept  would  involve  a minimum  stan- 
dard program  with  the  federal  government  paying 
for  poor  and  others  paying  their  own  way  as  in- 
dividuals or  employer-employee  groups.  Of  this 
group.  Rep.  John  Dingell  (D.,  Mich.)  already  has 
submitted  a bill.  Sen.  Jacob  Javits  (R.,  N.Y. ) may 
submit  a bill  to  expand  Medicare  to  all  and  pos- 
sibly convert  Blue  Gross  and  Blue  Shield  into  “pub- 
lic utilities”  to  administer  his  program. 

Group  Three — Gomprehensive,  cradle-to-grave, 
full  coverage — compulsory  for  everyone — adminis- 
tered by  federal  government  with  built-in  incen- 
tives to  change  the  delivery  system  from  fee-for- 
service  to  prepaid  group  practice. 

Primary  spokesmen  for  this  group  are  the  AFL- 
GIO  and  the  UAW.  Bills  in  this  group  will  empha- 
size use  of  the  financing  system  as  a lever  to  effect 
change  in  the  delivery  system. 

The  crux  of  the  problem  isn’t  whether  access  to 
health  care  is  a right — everyone  agrees  it  is — or 
whether  we  should  have  some  system  of  making  it 
available — no  one  is  opposed  to  that  per  se.  The 
ways  and  means  will  be  what  the  battle  is  about, 
and  pressure  for  NHI  should  hit  peak  during  the 
1972  election. 


(This  is  not  an  advertisement) 


The 

President’s 

Page 


J.  Ernest  Breed 


Health  care  delivery  changes  loom 


Catastrophic  changes  in  the  delivery  of 
medical  care  are  imminent.  These  are  be- 
ing brought  about  by  several  factors— in- 
creased demand,  shortage  of  jahysicians  and 
facilities,  and  the  high  cost  of  service.  It  is 
obvious  the  medical  profession  must  up- 
date its  delivery  system,  utilizing  more  al- 
lied medical  personnel,  modern  communi- 
cation systems,  data  storage  and  modern 
business  methods. 

Overwhelming  pressures  are  brought 
about  by  the  clamor  for  services  from  the 
public,  the  efforts  of  politicians  to  escape 
criticism  for  unfulfilled  promises  of  free 
medical  care,  the  demand  of  the  socialists 
for  complete  medical  care  for  all  paid  for 
by  the  “rich,”  and  the  declaration  that 
health  care  is  a “right.”  The  pressure  from 
the  masses  is  predicated  upon  need  and 
must  be  fulfilled,  while  the  pressures  from 
socialists  chiefly  give  lip  service  to  the  needs 
of  society  while  seeking  control. 

The  proposed  solutions  are  as  numer- 
ous as  the  pressure  groups.  Before  the 
House  Ways  & Means  Committee  is  a plan 
fostered  by  Hew  which  would  turn  over  to  a 
not-for-profit  organization  a contract  paying 
a fixed  sum  for  the  complete  care  of  Medi- 
care and  Medicaid  recipients.  A similar  sys- 
tem, embracing  all  people,  is  the  aim  of 
the  socialists,  spear  headed  by  the  Citizens 
Committee  of  One  Hundred,  formerly  head- 
ed by  Walter  Reuther.  Realizing  the  ne- 
cessity for  some  type  of  comprehensive  in- 
surance the  AMA  has  had  a bill  introduced 
in  Congress  entitled  “Medi-Credit.”  This 
is  a plan  to  purchase  comprehensive  insur- 
ance with  credit  for  the  premium  being  al- 


lowed on  one’s  income  tax  and  for  govern- 
ment payment  of  the  premiums  for  the 
indigent. 

One  thing  is  sure,  no  matter  what  final 
form  we  embrace,  doctors  in  general  are 
going  to  have  to  work  in  groups  utilizing 
modern  scientific  facilities  and  many  allied 
health  assistants.  For  efficient  service  it  is 
essential  for  physicians  to  control  the 
groups. 

Threatened  with  Kaiser  Foundation 
closed  panel  groups,  owned  and  operated 
by  non-physicians,  and  with  doctors  on  a 
salary,  county  medical  Societies  in  Southern 
California  organized  “Health  Care  Foun- 
dations” providing  full  service,  including 
hospitalization.  Free  choice  of  physician 
and  fee-for-service  are  included.  If  a physi- 
cian signed  with  the  Foundation,  he  was 
obligated  to  accept  a fixed  fee  for  his  serv- 
ices, based  upon  the  California  Relative 
Value  Study.  If  he  did  not  wish  to  sign 
up  he  understood  that  the  fixed  fee  would 
be  paid  by  the  Foundation,  and  if  his 
charges  exceeded  this  fee  he  would  have  to 
collect  the  balance  from  the  patient.  The 
whole  system  is  rigidly  controlled  by  a 
Peer  Review  Committee  of  the  physicians 
themselves. 

The  Foundations  for  Medical  Care  have 
been  very  successful  and  many  more  are 
in  the  process  of  formation.  The  State 
Medical  Societies  of  Colorado  and  New 
Mexico  are  in  the  process  of  setting  up 
statewide  Foundations. 

Doctors  are  fearful  of  closed  panel  groups 
such  as  the  Kaiser  Clinics,  since  the  major 
concern  of  non-professional  management 


for  October,  1970 


297 


is  money,  not  patient  welfare.  Only  a few 
physicians  would  be  employed  in  an  area 
and  doctors  would  lose  control  of  the  prac- 
tice of  medicine.  Free  choice  as  well  as  fee 
for  service  would  be  obviated. 

It  is  reported  that  a number  of  hospitals 
in  Illinois  are  contemplating  setting  up 
closed  panel  groups.  For  this  reason  a num- 
ber of  Illinois  counties  are  seriously  con- 
sidering establishing  Foundations  for  Medi- 
cal Care. 

I again  urge  Illinois  doctors  to  voluntari- 
ly organize  into  corporate  or  partnership 
multi-discipline  groups.  If  the  doctors  in 
an  area  are  organized,  obviously  the  fed- 
eral government,  unions  or  other  organiza- 
tions wishing  to  provide  pre  paid  care  must 
negotiate  with  them.  The  control  of  medi- 


September  2,  1970 

Sir: 

The  plan  as  proposed  by  Dr.  Samuel  K.  Lewis,  in  his 
article  “Future  Forensic  Medicine  in  Illinois”  (7/1/7,  March, 
1970)  is  an  ambitious  pipe  dream  but  not  realistic  fact. 
The  number  of  medical  schools  that  have  chairs  in  the 
Forensic  Sciences  have  dwindled  to  next  to  nothing,  and 
at  the  present  time  the  outlook  remains  dismal.  Creating 
magnanimous  centers  is  idealistic — the  full-time  staff  is, 
however,  not  available.  Every  year,  the  American  Board  of 
Pathology  certifies  15  or  so  pathologists  in  the  specialized 
field  of  Forensic  Pathology.  This  does  not  meet  the  needs 
of  the  country,  and  those  of  us  certified — do  not  consider 
ourselves  medical  administrators. 

The  Baker  Bill,  the  basic  medical  examiner  law  in  the 
United  States,  with  certain  modifications,  outlines  very 
clearly  what  cases  come  under  the  jurisdiction  and  aegis 
of  the  medical  examiner.  The  medical  examiner’s  system 
is  not  new  in  the  United  States.  It  has  been  functioning 
in  some  jurisdictions  since  before  the  turn  of  the  century. 
Replacing  the  lay  coroner  by  a physician  who  is  not  trained 
or  qualified  to  cope  with  problems  that  arise  in  the  day 
to  day  operation  of  a medical  examiner’s  office,  does  not 
improve  the  system.  Training  in  hospital  pathology  does 
not  give  one  expertise  in  the  Forensic  Sciences.  The  pro- 
posed seven  regional  centers,  plus  Cook  County  would  be 
an  exorbitant  expense  which  the  Illinois  Legislature,  or  for 
that  matter,  any  legislature,  would  refuse  to  support. 

A more  realistic  approach,  on  a regional  basis,  would 
be  to  enlarge  the  facilities  that  are  presently  available  or 


cine  then  will  remain  in  the  hands  of  doc- 
tors. 

On  November  15,  the  ISMS  will  present 
a conference  on  “Health  Care  Delivery 
Changes  in  the  70’s”  at  the  Continental 
Plaza,  Chicago.  Arrangements  have  been 
made  by  Jacob  Reisch,  M.D.,  who  stated 
“this  will  be  the  most  important  leadership 
conference  we’ve  ever  had.  Medicine  is  go- 
ing to  change  drastically  in  the  1970’s, 
whether  we  like  it  or  not.”  Come  to  learn 
the  problems  and  assist  in  finding  the  an- 
swers. 


could  easily  be  made  available  and  where  expertise  is  al- 
ready on  hand.  An  example  of  that  would  be  to  funnel  pro- 
posed Districts  1,  2,  and  3 into  the  Office  of  the  Chief 
Medical  Examiner  of  the  County  of  St.  Louis,  Missouri, 
or  parts  of  Districts  3,  4,  and  5 to  expertise  at  the  medical 
school  in  Iowa  City,  just  across  the  river,  and  finally  Dis- 
tricts 4,  5,  6,  and  7 straight  into  the  Chicago  area.  This 
type  of  redistricting,  however,  would  preclude  political 
rearrangement  and  lessening  of  local  petty  politics.  In  the 
long  run,  the  tax  payer,  the  person  that  should  be  served 
and  who  has  to  foot  the  bill,  would  be  the  winner. 

Finally,  although  physicians  must  be  the  medical  ex- 
aminers and  the  system  has  to  be  encouraged  by  the  medi- 
cal society,  it  is  the  law  enforcement  and  parajudicial 
agencies  which  must  not  only  support,  but  actively  co- 
operate with  any  well  functioning  system. 

Sincerely, 

Walter  I.  Hofman,  M.D. 

Medical  Examiner,  Dallas  County 

Southwestern  Institute  of  Forensic  Sciences  at  Dallas 


Ed,  note:  Membership  Forum  is  a means  for 
the  ISMS  physician  to  express  opinion  and  view- 
point on  varied  topics.  If  you  have  an  item  you 
would  like  brought  before  your  fellow  practitioners, 
please  submit  it  to  Membership  Forum,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave.,  Chicago 
60601.  Communications  should  not  exceed  250  words. 
The  right  to  abstract  or  edit  is  reserved.  Names  will 
be  withheld  upon  request,  but  anonymous  letters 
will  not  be  accepted. 


298 


Illinois  Medical  Journal 


volume  138,  number  4 


oclober,  1970 


ISMS  ORGANIZATION 


History  of 


Founding  and  Expansion 


Twenty-nine  Physicians  met  in  Springfield 
June  4,  1850,  to  organize  on  a permanent  basis 
the  Illinois  State  Medical  Society,  which  had  been 
started  informally  10  years  earlier.  The  founders 
were  concerned  with  the  solution  of  ethical,  scien- 
tific, legislative  and  economic  problems.  The  first 
Constitution  and  Bylaws  and  the  first  Code  of 
Medical  Ethics  were  adopted;  the  first  legislative 
committee  was  appointed,  and  a resolution  out- 
lining the  beginnings  of  interprofessional  relations 
was  approved. 

The  Legislative  Committee  was  instructed  to 
“memorialize  the  legislature  at  its  next  session, 
praying  the  enactment  of  a statute  providing  for 
the  registration  of  Births,  Deaths  and  Marriages.” 
The  resolution  ruled  that  “members  of  the  Society 
will  discourage  the  sale  of  patent  or  secret  nos- 
trums on  the  part  of  Druggists  and  Apothecaries 
throughout  the  State,  and  will  patronize  insofar 
as  practicable,  only  those  who  abstain  from  the 
sale  of  such  patent  or  secret  nostrums.” 

The  first  full  time  secretary  of  the  Society  was 
Dr.  Harold  M.  Camp  who  served  for  over  35 
years  until  his  death  in  1958.  The  first  executive 
administrator,  Robert  L.  Richards,  was  employed 
at  the  time  the  office  was  moved  to  Chicago  in 
1960  and  served  until  February,  1966.  After  an 
interim  service  by  Dr.  George  F.  Lull,  Mr.  Roger 
N.  White  was  selected  as  Executive  Administrator 
in  May,  1968. 

The  Society  published  the  early  transactions  in 


book  form  presenting  not  only  the  minutes  of  the 
House  of  Delegates,  but  also  all  scientific  papers 
given  at  each  annual  convention.  In  1898  a new 
era  of  communications  began,  for  at  that  time, 
the  Illinois  Medical  Journal  was  established  and 
became  the  first  “official  organ  of  the  Society.” 

Dr.  G.  N.  Kreider  was  its  first  editor  and  served 
until  1913,  followed  by  Dr.  Clyde  D.  Pence  with 
Dr.  Henry  G.  Olds  as  the  first  managing  editor. 
Dr.  Charles  G.  Whalen  became  editor  in  1919  and 
he  and  Dr.  Olds  served  until  they  died  in  1940. 
Dr.  Camp  followed  Dr.  Whalen  and  Dr.  Theodore 
R.  Van  Dellen  is  the  editor  today. 

Dr.  Whalen  spearheaded  many  important  activi- 
ties in  medicine,  and  has  been  called  “the  outstand- 
ing champion  of  the  medical  profession  in  its 
economic  contacts.”  He  has  been  credited  as  one 
of  the  first  medical  editors  to  blast  “the  socializa- 
tion of  medicine  in  this  country.”  In  1922  he  wrote 
extensively  on  state  medicine,  workmen’s  compen- 
sation, compulsory  health  insurance,  free  hospital- 
ization and  federal  aid. 

The  first  Fifty  Year  Club  in  the  United  States 
was  announced  by  the  Illinois  Medical  Journal  in 
1938. 

The  fourth  largest  medical  society  in  the  coun- 
try has  developed  from  these  embryonic  begin- 
nings. This  edition  of  the  Illinois  Medical  Journal 
offers  you  an  opportunity  to  contrast  the  extensive 
services  available  to  the  membership  today  with 
those  offered  in  the  past. 


ior  October,  1970 


health  SCIENCiS  ^10^1 
university  of 


323 


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1880 

1881 

1882 

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1886 

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191  I 

r.2-1 


OFFICERS  AND  PLACES  OF  MEETING 


President 

Secretary 

Treasurer 

Meeting  Place 

John  Todd 

David  Prince 

Springfield 

Rudolph  Rouse 

Edwin  G.  Meek 

Springfield 

William  B.  Herrick 

Edwin  G.  Meek 

Jno.  Halderman 

Springfield 

Samuel  Thompson 

H.  Shoemaker 

R.  Rouse 

Peoria 

Rudolph  Rouse 

E.  S.  Cooper 

Edw.  Dickenson 

Jacksonville 

Daniel  Brainerd 

H.  A.  J.  Iinscn 

A.  B.  Chambers 

Chicago 

C.  N.  Andrews 

H.  A.  Jolmson 

N.  S.  Davis 

LaSalle 

N.  S.  Davis 

E.  Andrews 

J.  V.  Z.  Blaney 

Bloomington 

H.  Noble 

N.  S.  Davis 

J.  V.  Z.  Blaney 

Vandalia 

C.  Goodbreak 

H.  A.  Johnson 

J.  V.  Z.  Blaney 

Chicago 

H.  A.  Johnson 

N.  S.  Davis 

J.  W.  Freer 

Rockford 

David  Prince 

N.  S.  Davis 

J.  W.  Freer 

Decatur 

Wm.  M.  Chambers 

N.  S.  Davis 

J.  W.  Freer 

Paris 

A.  McFarland 

N.  S.  Davis 

J.  H.  Hollister 

Jacksonville 

A.  H.  Luce 

N.  S.  Davis 

J.  H.  Hollister 

Chicago 

J.  M.  Steele 

N.  S.  Davis 

J.  H.  Hollister 

Bloomington 

F.  F.  Haller 

N.  S.  Davis 

J.  H.  Hollister 

Decatur 

H.  Noble 

N.  S.  Davis 

J.  H.  Hollister 

Springfield 

S.  T.  Trowbridge 

N.  S.  Davis 

J.  H.  Hollister 

Quincy 

S.  T.  Trowbridge 

T.  D.  Fitch 

J.  H.  Hollister 

Chicago 

J.  V.  Z.  Blaney 

T.  D.  Fitch 

J.  H.  Hollister 

Dixon 

G.  W.  Albin 

T.  D.  Fitch 

J.  H.  Hollister 

Peoria 

J.  0.  Hamilton 

T.  D.  Fitch 

J.  H.  Hollister 

Rock  Island 

D.  W.  Young 

T.  D.  Fitch 

J.  H.  Hollister 

Bloomington 

T.  F.  Worrell 

T.  D.  Fitch 

J.  H.  Hollister 

Chicago 

J.  H.  Hollister 

T.  D.  Fitch 

Wm.  E.  Quine 

Jacksonville 

T.  D.  Washburn 

N.  S.  Davis 

J.  H.  Hollister 

Urbana 

T.  D.  Fitch 

N.  S.  Davis 

J.  H.  Hollister 

Chicago 

J.  L.  White 

N.  S.  Davis 

J.  H.  Hollister 

Springfield 

E.  P.  Cook 

N.  S.  Davis 

J.  H.  Hollister 

Lincoln 

Ephraim  Ingalls 

N.  S.  Davis 

J.  H.  Hollister 

Belleville 

G. W.  Jones 

S.  J.  Jones 

J.  H.  Hollister 

Chicago 

Robert  Boal 

S.  J.  Jones 

J.  H.  Hollister 

Quincy 

A.  T.  Darrah 

S.  J.  Jones 

J.  H.  Hollister 

Peoria 

E.  Andrews 

S.  J.  Jones 

Walter  Hay 

Chicago 

D.  S.  Booth 

S.  J.  Jones 

Walter  Hay 

Springfield 

Wm.  A.  Byrd 

S.  J.  Jones 

Walter  Hay 

Bloomington 

Wm.  T.  Kirk 

D.  W.  Graham 

Walter  Hay 

Chicago 

Wm.  O.  Ensign 

D.  W.  Graham 

Walter  Hay 

Rock  Island 

C.  W.  Earle 

D.  W.  Graham 

T.  W.  Mcllvaine 

Jacksonville 

John  Wright 

D.  W.  Graham 

T.  W.  Mcllvaine 

Chicago 

Jno.  P.  Mathews 

D.  W.  Graham 

Geo.  N.  Kreider 

Springfield 

Charles  C.  Hunt 

D.  W.  Graham 

Geo.  N.  Kreider 

Vandalia 

E.  Ehtcher  Ingals 

D.  W.  Graham 

Geo.  N.  Kreider 

Chicago 

Otho  B.  Will 

J.  B.  Hamilton 

Geo.  N.  Kreider 

Decatur 

Daniel  R.  Brower 

J.  B.  Hamilton 

Geo.  N.  Kreider 

Springfield 

D.  W.  Graham 

J.  B.  Hamilton 

Geo.  N.  Kreider 

Ottawa 

A.  C.  Corr 

J.  B.  Hamilton 

Geo.  N.  Kreider 

East  St.  Louis 

J.  N.  G.  Carter 

E.  W.  Weis 

Geo.  N.  Kreider 

Galesburg 

J.  T.  Pitner 

E.  W.  Weis 

Geo.  N.  Kreider 

Cairo 

H.  N.  Moyer 

E.  W.  Weis 

Geo.  N.  Kreider 

Springfield 

G.  N.  Kreider 

E.  W.  Weis 

E.  J.  Brown 

Peoria 

J.  T.  McAnally 

E.  W.  Weis 

E.  J.  Brown 

Quincy 

M.  L.  Harris 

E.  W.  Weis 

E.  J.  Brown 

Chicago 

C.  E.  Black 

E.  W.  Weis 

E.  J.  Brown 

Bloomington 

W.  E.  Quine 

E.  W.  Weis 

E.  J.  Brown 

Rock  Island 

H.  C.  Mitchell 

E.  W.  Weis 

E.  J.  Brown 

Springfield 

J.  F.  Percy 

E.  W.  Weis 

E.  J.  Brown 

Rockford 

W.  L.  Baum 

E.  W.  Weis 

E.  J.  Brown 

Peoria 

1 W.  Pettit 

E.  W.  Weis 

E.  J.  Brown 

Quincy 

J.  L.  Wiggins 

E.  W.  Weis 

E.  ,1.  Brown 

Danville 

A.  C.  Cotton 

E.  W.  Weis 

E.  J.  Brown 

Aurora 

Illinois  Medical  Joiininl 


Year 

President 

Secretary 

Treasurer 

Meeting  Place 

1912 

W.  K.  Newcomb 

E.  W.  Weis 

E.  J.  Brown 

Springfield 

1913 

L.  H.  A.  Nickerson 

E.  W.  Weis 

A.  J.  Markley 

Peoria 

1914 

Charles  J.  Whalen 

W.  H.  Gilmore 

A.  J.  Markley 

Decatur 

1915 

A.  L.  Brittin 

W.  H.  Gilmore 

A.  J.  Markley 

Springfield 

1916 

C.  W.  Lillie 

W.  H.  Gilmore 

A.  J.  Markley 

Champaign 

1917 

W.  L.  Noble 

W.  H.  Gilmore 

A.  J.  Markley 

Bloomington 

1918 

E.  B.  Coolley 

W.  H.  Gilmore 

A.  J.  Markley 

Springfield 

1919 

E.  W.  Fiegenbaum 

W.  H.  Gilmore 

A.  J.  Markley 

Peoria 

1920 

J.  W.  Van  Derslice 

W.  H.  Gilmore 

A.  J.  Markley 

Rockford 

1921 

W.  F.  Grinstead 

W.  H.  Gilmore 

A.  J.  Markley 

Springfield 

1922 

Charles  Humiston 

W.  H.  Gilmore 

A.  J.  Markley 

Chicago 

1923 

E.  P.  Sloan 

W.  D.  Chapman 

A.  J.  Markley 

Decatur 

1924 

E.  H.  Ochsner 

W.  D.  Chapman 

A.  J.  Markley 

Springfield 

1925 

L.  C.  Taylor 

H.  M.  Camp 

A.  J.  Markley 

Quincy 

1926 

J.  C.  Krafft 

H.  M.  Camp 

A.  J.  Markley 

Champaign 

1927 

Mather  Pfeiffenberger 

H.  M.  Camp 

A.  J.  Markley 

Moline 

1928 

G.  Henry  Mundt 

H.  M.  Camp 

A.  J.  Markley 

Chicago 

1929 

J.  E.  Tuite 

H.  M.  Camp 

A.  J.  Markley 

Peoria 

1930 

F.  O.  Fredrickson 

H.  M.  Camp 

A.  J.  Markley 

Joliet 

1931 

Wm.  D.  Chapman 

H.  M.  Camp 

A.  J.  Markley 

East  St.  Louis 

1932 

R.  R.  Ferguson 

H.  M.  Camp 

A.  J.  Markley 

Springfield 

1933 

John  R.  Neal 

H.  M.  Camp 

A.  J.  Markley 

Peoria 

1934 

Philip  H.  Kreuscher 

H.  M.  Camp 

A.  J.  Markley 

Springfield 

1935 

Charles  D.  Center* 

(Past  President-Elect) 

1935 

Charles  S.  Skaggs 

H.  M.  Camp 

A.  J.  Markley 

Rockford 

1936 

Chas.  B.  Reed 

H.  M.  Camp 

A.  J.  Markley 

Springfield 

1937 

Rolland  L.  Green 

H.  M.  Camp 

A.  J.  Markley 

Peoria 

1938 

R.  K.  Packard 

H.  M.  Camp 

A.  J.  Markley 

Springfield 

1939 

S.  E.  Munson 

H.  M.  Camp 

A.  J.  Markley 

Rockford 

1940 

Jas.  H.  Hutton 

H.  M.  Camp 

A.  J.  Markley 

Peoria 

1941 

J.  S.  Templeton 

H.  M.  Camp 

A.  J.  Markley 

Chicago 

1942 

Chas.  H.  Phifer 

H.  M.  Camp 

H.  M.  Camp 

Springfield 

1943 

E.  H.  Weld 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1944 

G.  W.  Post** 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1945 

E.  P.  Coleman 

H.  M.  Camp 

H.  M.  Camp 

^ ^ ^ 

1946 

E.  P.  Coleman 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1947 

R.  S.  Berghoff 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1948 

I.  H.  Neece 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1949 

Percy  E.  Hopkins 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1950 

Walter  Stevenson 

H.  M.  Camp 

H.  M.  Camp 

Springfield 

1951 

Harry  M.  Hedge 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1952 

C.  Paul  White 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1953 

Leo  P.  A.  Sweeney 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1954 

Willis  I.  Lewis 

H.  M.  Camp 

H.  M.  C?.mp 

Chicago 

1955 

Arkell  M.  Vaughn 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1956 

F.  Garm  Norbury 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1957 

F.  Lee  Stone 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1958 

Lester  S.  Reavley 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1959 

Raleigh  C.  Oldfield 

H.  M.  Camp 

H.  M.  Camp 

Chicago 

1960 

Joseph  T.  O’Neill 

George  F.  Lull 

George  F.  Lull 

Chicago 

1961 

H.  Close  Hesseltine 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1962 

Edwin  S.  Hamilton 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1963 

George  F.  Lull 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1964 

Harlan  English 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1965 

Edward  A.  Piszczek 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1966 

Burtis  E.  Montgomery 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1967 

Caesar  Portes 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1968 

Newton  DuPuy 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1969 

Philip  G.  Thomsen 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1970 

Edward  W.  Cannady 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

1971 

J.  Ernest  Breed 

Jacob  E.  Reisch 

Jacob  E.  Reisch 

Chicago 

•Died  before  induction  into  office 

••Died  in  office.  Term  completed  by  Robert  S.  Berghoff,  First  Vice  President 
• ••Meeting  cancelled  1946 


for  October,  1970 


325 


Principles  Of  Medical  Ethics 


Preamble:  These  principles  are  intended  to  aid 
physicians  individually  and  collectively  in  main- 
taining a high  level  of  ethical  conduct.  They  are 
not  laws  but  standards  by  which  a physician 
may  determine  the  propriety  of  his  conduct  in 
his  relationship  with  patients,  with  colleagues, 
with  members  of  allied  professions,  and  with  the 
public. 

Section  1 — The  principal  objective  of  the  medi- 
cal profession  is  to  render  service  to  humanity 
with  full  respect  for  the  dignity  of  man.  Physicians 
should  merit  the  confidence  of  patients  entrusted 
to  their  care,  rendering  to  each  a full  measure  of 
service  and  devotion. 

Section  2 — Physicians  should  strive  continually 
to  improve  medical  knowledge  and  skill,  and 
should  make  available  to  their  patients  and  col- 
leagues the  benefits  of  their  professional  attain- 
ments. 

Section  3 — A physician  should  practice  a method 
of  healing  founded  on  a scientific  basis;  and  he 
should  not  voluntarily  associate  professionally  with 
anyone  who  violates  this  principle. 

Section  4 — The  medical  profession  should  safe- 
guard the  public  and  itself  against  physicians 
deficient  in  moral  character  or  professional  compe- 
tence. Physicians  should  observe  all  laws,  uphold 
the  dignity  and  honor  of  the  profession  and 
accept  its  self-imposed  disciplines.  They  should 
expose,  without  hesitation,  illegal  or  unethical  con- 
duct of  fellow  members  of  the  profession. 

Section  5 — A physician  may  choose  whom  he 
will  serve.  In  an  emergency,  however,  he  should 
render  service  to  the  best  of  his  ability.  Having 
undertaken  the  care  of  a patient,  he  may  not 
neglect  him;  and  unless  he  has  been  discharged  he 
may  discontinue  his  services  only  after  giving 


adequate  notice.  He  should  not  solicit  patients. 

Section  6 — A physician  should  not  dispose  of  his 
services  under  terms  or  conditions  which  tend  to 
interfere  with  or  impair  the  free  and  complete 
exercise  of  his  medical  judgment  and  skill  or  tend 
to  cause  a deterioration  of  the  quality  of  medical 
care. 

Section  7 — In  the  practice  of  medicine  a physician 
should  limit  the  source  of  his  professional  income 
to  medical  services  actually  rendered  by  him,  or 
under  his  supervision,  to  his  patients.  His  fee 
should  be  commensurate  with  the  services  rendered 
and  the  patient’s  ability  to  pay.  He  should  neither 
pay  nor  receive  a commission  for  referral  of  pa- 
tients. Drugs,  remedies  or  appliances  may  be 
dispensed  or  supplied  by  the  physician  provided 
it  is  in  the  best  interests  of  the  patient. 

Section  8 — A physician  should  seek  consultation 
upon  request,  in  doubtful  or  difficult  cases;  or 
whenever  it  appears  that  the  quality  of  medical 
service  may  be  enhanced  thereby. 

Section  9 — A physician  may  not  reveal  the 
confidences  entrusted  to  him  in  the  course  of 
medical  attendance,  or  the  deficiencies  he  may 
observe  in  the  character  of  patients,  unless  he 
is  required  to  do  so  by  law  or  unless  it  becomes 
necessary  in  order  to  protect  the  welfare  of  the 
individual  or  of  the  community. 

Section  10 — The  honored  ideals  of  the  medical 
profession  imply  that  the  responsibilities  of  the 
physician  extend  not  only  to  the  individual,  but 
also  to  society  where  these  responsibilities  deserve 
his  interest  and  participation  in  activities  which 
have  the  purpose  of  improving  both  the  health 
and  the  well-being  of  the  individual  and  the 
community. 


326 


Illinois  Medical  Journal 


Constitution  And  Bylaws 
May  1970 

Adopted,  1903 
As  Amended,  1970 


CONSTITUTION 


ARTICLE  I.  NAME 

1 he  name  and  title  of  this  organization  shall  be 
the  Illinois  State  Medical  Society. 

ARTICLE  II.  PURPOSES  OF  THE  SOCIETY 
The  purposes  of  this  Society  are  to  promote  the 
science  and  art  of  medicine,  to  protect  the  public 
health,  to  elevate  the  standards  of  medical  educa- 
tion and  to  unite  the  medical  profession  behind 
these  purposes;  to  promote  similar  interests  in  the 
component  societies  and  to  unite  with  similar 
organizations  in  other  states  and  territories  of  the 
United  States  to  form  the  American  Medical 
Association.  The  Society  shall  inform  the  public 
and  the  profession  concerning  the  advancements 
in  medical  science  and  the  advantages  of  proper 
medical  care. 

ARTICLE  III.  COMPONENT  SOCIETIES 
Component  societies  shall  consist  of  those  county 
medical  societies  which  hold  charters  from  this 
Society. 

ARTICLE  IV.  COMPOSITION  OF  THE 
SOCIETY 

The  Society  shall  consist  of  active  members  and 
such  other  members  as  the  Bylaws  may  provide. 

ARTICLE  V.  HOUSE  OF  DELEGATES 
Section  1.  The  House  of  Delegates  shall  be  the 
legislative  body  of  the  Illinois  State  Medical 
Society,  and  unless  otherwise  herein  provided,  its 
deliberations  shall  be  binding  upon  the  officers, 
including  the  Board  of  Trustees.  The  House  of 
Delegates  shall  set  the  basic  policy  and  philosophy 
of  the  Society. 

Section  2.  The  House  of  Delegates  shall  elect  the 
general  officers,  except  as  otherwise  provided  in 
the  Bylaws. 


ARTICLE  VI.  BOARD  OF  TRUSTEES 

The  Board  of  Trustees,  whose  duties  are  executive 
and  judicial,  shall  have  charge  of  all  property  and 
all  financial  affairs  of  the  Society,  and  shall  per- 
form such  other  duties  as  are  prescribed  by  law 
governing  the  directors  of  corporations,  or  as  may 
be  prescribed  in  the  Bylaws. 

ARTICLE  VII.  CONVENTIONS  AND 
MEETINGS 

The  Society  shall  hold  an  annual  convention  during 
which  there  shall  be  a business  meeting  of  the 
House  of  Delegates  and  general  scientific  meetings 
which  shall  be  open  to  all  registered  members. 

ARTICLE  VIII.  OFFICERS 

The  officers  of  this  Society  shall  be  a president,  a 
president-elect,  a first  vice  president,  a second 
vice  president,  a secretary-treasurer,  a speaker 
and  vice  speaker  of  the  House  of  Delegates,  sixteen 
trustees  and  one  trustee  at  large,  and  such  other 
officers  as  the  Bylaws  may  provide. 

ARTICLE  IX.  THE  SEAL 

This  Society  shall  have  a common  seal  with  power 
to  break,  change  or  renew  the  same  when  neces- 
sary. 

ARTICLE  X.  AMENDMENTS 

The  House  of  Delegates  may  amend  this  Constitu- 
tion at  any  annual  business  meeting  of  the  House 
of  Delegates  provided  that  the  amendment  shall 
have  been  proposed  at  the  preceding  annual  busi- 
ness meeting,  and  that  two-thirds  of  the  members 
of  the  House  of  Delegates  seated  concur  in  the 
amendment. 


BYLAWS 


CHAPTER  L MEMBERSHIP 
Section  1.  Members. 

A.  Active  Members.  The  active  members  of  this 
Society  shall  consist  of  regular  members, 
emeritus  members,  retired  members,  provi- 
sional members,  intern  members  and  resi- 
dency members.  Active  members  shall  enjoy 
full  privileges  which  include  membership  in 
the  American  Medical  Association. 


B.  Special  Members.  The  special  members  of 
this  Society  shall  be  distinguished  because  of 
their  contributions  to  the  science  and  art  of 
medicine. 

(1)  Distinguished  Members.  Distinguished 
members  shall  be; 

a.  Physicians  of  Illinois  or  other 
states,  or  foreign  countries  who 
have  risen  to  prominence  in  the 
profession;  or 


/or  October,  1970 


327 


b.  Teachers  of  medicine  or  of  the 
sciences  allied  to  medicine,  not 
eligible  for  active  membership:  or 

c.  Members  of  associated  arts  or 
sciences  who  have  made  signifi- 
cant contributions  to  medicine. 

(2)  Election.  Special  members  may  be 
nominated  by  any  member  of  the 
House  of  Delegates,  and  may  be  elected 
by  the  House  at  any  annual  convention 
by  a two-thirds  vote. 

(3)  Privileges.  Special  members  shall  not 
be  entitled  to  hold  office  nor  to  vote, 
and  shall  not  be  considered  as  mem- 
bers in  determining  the  number  of 
delegates  to  the  American  Medical 
Association,  but  they  may  participate 
in  all  other  Society  activities. 

Section  2.  Qualifications  for  Membership. 

A.  Every  physician  duly  licensed  and  registered 
in  the  State  of  Illinois  to  practice  medicine  in 
all  its  branches  who  is  a resident  of  the  State 
of  Illinois,  a citizen  of  the  United  States, 
who  is  of  good  moral  character  and  profes- 
sional standing,  and  a member  of  his  com- 
ponent medical  society,  shall  be  eligible  for 
regular  membership. 

B.  Provisional  membership  shall  be  available  to 
any  Illinois  physician  who  has  made  a dec- 
laration of  intention  to  become  a citizen  of 
the  United  States,  who  has  received  a license 
in  this  State  to  practice  medicine  in  all  of  its 
branches,  and  who — with  the  exception  of 
United  States  citizenship — possesses  all  of  the 
qualifications  for  membership  prescribed  by 
these  Bylaws.  Provisional  membership  shall 
terminate  one  year  after  the  expiration  of 
the  minimum  period  of  time  within  which 
such  member  could  have  perfected  his  citizen- 
ship. After  obtaining  full  citizenship  and 
prior  to  the  expiration  of  his  provisional 
membership,  such  member  may  be,  upon  ap- 
plication to  his  component  medical  society, 
transferred  to  regular  membership. 

C.  The  following  shall  also  be  eligible  if  ap- 
proved and  recommended  by  the  component 
medical  society: 

( 1 ) Every  physician  serving  as  a full  time 
employee  at  the  headquarters  of  the 
American  Medical  Association: 

(2)  Physicians  serving  as  medical  officers 
in  the  United  States  Governmental 
Services,  who  are  members  of  a com- 
ponent society,  so  long  as  they  are  en- 
gaged actively  full-time  in  their  respec- 
tive service,  and  thereafter,  if  they 
have  been  retired  on  account  of  age 
or  physical  disability,  or  after  long 
and  honorable  service  under  the  pro- 
vision of  an  Act  of  Congress: 


D.  Physicians  otherwise  eligible  for  membership, 
and  licensed  in  one  of  the  States  of  the 
Union,  but  not  licensed  in  Illinois,  and  who 
are  not  engaged  in  the  active  practice  of 
medicine,  but  otherwise  employed  in  an  allied 
medical  activity  which  does  not  require  licen- 
sure, shall  be  eligible  for  membership  if  ap- 
proved and  recommended  by  the  component 
medical  society  and  approved  by  the  Board 
of  Trustees. 

Section  3.  Emeritus  Members.  A member  to  be 
elected  to  emeritus  membership  shall: 

currently  be  in  good  standing,  have  been 
a member  in  good  standing  for  35  years, 
have  reached,  or  will  have  reached  before 
the  next  fiscal  year,  the  age  of  70  years, 
and  have  made  written  application  to  and 
have  been  recommended  by  his  compon- 
ent society  for  emeritus  status. 

Such  membership  shall  become  effective  Jan- 
uary 1 of  the  year  following  election.  Emeritus 
members  shall  have  all  the  rights  and  privileges 
of  membership  without  the  payment  of  dues  to  the 
component  or  state  society. 

Credit  for  membership  in  other  American  Medi- 
cal Association  constituent  societies  shall  be 
accorded  transferees,  provided  they  have  been 
members  of  this  Society  for  at  least  five  years. 
Section  4.  Retired  Members.  A member  who  has 
been  in  good  standing  but  who  by  reason  of  age 
or  incapacity,  has  retired  from  active  practice,  may 
upon  application  to  and  upon  recommendation  of 
his  component  society,  be  made  a retired  member, 
without  payment  of  dues  to  the  component  or  state 
society. 

Section  5.  Intern  Members.  Any  person  who  is  a 
graduate  of  a medical  school,  who  is  of  good 
moral  character  and  professional  standing  and 
serving  an  internship  in  any  hospital  in  the  State 
of  Illinois  approved  by  the  American  Medical 
Association,  is  eligible  for  intern  membership 
upon  the  recommendation  of  any  two  members 
of  this  Society  who  are  also  members  of  his  hos- 
pital staff. 

The  physician’s  intern  membership  shall  cease 
at  the  end  of  the  year  in  which  his  internship 
training  terminates,  and  if  he  wishes  to  become  a 
member  of  this  Society,  he  must  apply  for  a 
residency  or  regular  membership  through  his 
component  society. 

Dues  for  intern  membership  shall  be  minimal. 
Section  6.  Residency  Members.  After  being 
licensed  to  practice  medicine,  a physician  serving 
full  time  as  a resident  in  a residency  approved  by 
the  American  Medical  Association,  is  eligible  for 
full  membership. 

Dues  for  residency  members  shall  be  minimal. 

A residency  member  must  be  a graduate  of  a 
medical  school,  have  a degree  of  Doctor  of  Medi- 
cine or  its  equivalent,  and  must  be  a member  in 
good  standing  of  his  component  society. 


328 


Illinois  Medical  Journal 


The  physician’s  residency  membership  shall 
cease  at  the  end  of  the  year  in  which  his  residency 
training  terminates,  and  if  he  wishes  to  become  a 
member  of  this  Society,  he  must  apply  for  regular 
membership  through  his  component  society. 

Section  7.  Tenure  of  Membership.  The  name  of  a 
physician  on  the  properly  certified  roster  of  mem- 
bers of  a component  society  which  has  paid  its 
annual  assessments,  shall  be  prima  facie  evidence 
of  membership  in  this  Society,  and  afford  all  the 
rights  and  privileges  pertaining  thereto. 

Section  8.  Withdrawal  of  Privileges.  No  person 
who  is  under  sentence  of  suspension  or  expulsion 
from  a component  society,  shall  be  entitled  to  any 
of  the  rights  or  benefits  of  this  Society,  nor  shall 
he  be  permitted  to  take  part  in  any  of  the  pro- 
ceedings until  he  has  been  reinstated. 

Section  9.  Student  Committee  Membership.  Stu- 
dents nominated  by  Illinois  Chapters  of  the  Stu- 
dent American  Medical  Association,  or  other 
recognized  student  organizations  approved  by  the 
Illinois  State  Medical  Society  Board  of  Trustees, 
to  serve  with  Illinois  State  Medical  Society  mem- 
bers on  appropriate  committees,  may  by  action 
of  the  Board  of  Trustees,  be  accorded  member- 
ship in  this  classification  for  the  term  of  the 
committee  appointment.  Such  members  shall  be 
permitted  full  privileges  of  committee  member- 
ship, including  (with  permission  of  the  House 
of  Delegates)  the  right  to  speak  on  the  floor 
of  the  House,  but  shall  have  no  vote  out  of 
committee.  They  shall  pay  no  dues. 

CHAPTER  II.  ANNUAL  CONVENTIONS 
Section  1.  Date.  The  Board  of  Trustees  shall  de- 
termine the  date  for  the  annual  convention. 

Section  2.  Meeting  Place.  The  meeting  place  for 
the  annual  convention  shall  be  determined  by  the 
House  of  Delegates  from  a list  of  cities  extending 
invitations,  subject  to  investigation  of  the  facilities 
and  recommendation  by  the  Board  of  Trustees. 

Section  3.  Scientific  Meetings. 

.\.  With  the  consent  of  the  House  of  Delegates 
or  the  Board  of  Trustees  any  special  group 
may  conduct  its  meeting  in  connection  with 
the  annual  convention  of  this  Society. 

B.  The  Scientific  Program  shall  be  conceived 
by  the  Committee  on  Scientific  Assembly 
and  developed  and  implemented  through  the 
joint  efforts  of  the  Committee  on  Scientific 
Assembly  and  representatives  of  specialty 
groups. 

C.  All  registered  members  may  attend  and 
participate  in  the  proceedings  and  discus- 
sions of  the  general  scientific  meetings  and 
of  the  section  meetings. 

D.  The  general  scientific  meetings  may  recom- 
mend to  the  House  of  Delegates  the  appoint- 


ment of  committees  or  commissions  for  scien- 
tific investigation  of  special  interest  and  im- 
portance to  the  profession  and  to  the  public. 

E.  All  papers  read  before  the  Society  or  any 
section  thereof,  shall  become  the  property  of 
the  Society.  Each  paper  shall  be  deposited 
with  the  secretary  when  read,  and  presenta- 
tion of  a paper  to  the  Illinois  State  Medical 
Society  shall  be  considered  tantamount  to  the 
assurance  on  the  part  of  the  writer  that  such 
paper  has  not  already  been  published. 

F.  The  Board  of  Trustees  shall  be  entirely 
responsible  for  the  annual  convention. 

CHAPTER  III.  THE  HOUSE  OF 
DELEGATES 

Section  1.  Composition.  The  voting  membership 
of  the  House  of  Delegates  shall  consist  of; 

A.  Delegates  elected  by  the  component  societies 

B.  The  president 

C.  The  president-elect 

D.  The  secretary-treasurer 

E.  The  speaker  of  the  House  (or  the  vice 
speaker  when  presiding)  and 

F.  The  trustees. 

Non-voting  members  shall  be  the  vice  presidents, 
the  vice  speaker  (when  not  presiding),  the  past 
trustees,  past  speakers,  past  presidents,  general 
officers  of  the  AMA  and  delegates  from  the  Illi- 
nois State  Medical  Society  to  the  AMA. 

Section  2.  Meetings.  The  House  of  Delegates  shall 
meet  at  the  time  and  place  of  the  annual  conven- 
tion of  the  Society,  and  shall  fix  its  hours  of  meet- 
ing so  that  they  shall  not  conflict  with  the  general 
scientific  meetings  of  the  Society.  If  the  interests 
of  the  Society  and  the  profession  require,  the 
House  of  Delegates  may  meet  in  advance  of  the 
general  scientific  meetings. 

Section  3.  Quorum.  Fifty  delegates  representing 
not  less  than  twenty  component  societies  shall  con- 
stitute a quorum  for  the  transaction  of  business. 

Section  4.  Special  Meetings.  Special  meetings  of 
the  House  of  Delegates  may  be  called  by  the  presi- 
dent or  a majority  of  the  Board  of  Trustees,  or 
shall  be  called  on  petition  of  twenty  component 
societies. 

When  a special  meeting  is  thus  called,  the  secre- 
tary shall  mail  a notice  to  the  last  known  address 
of  each  member  of  the  House  of  Delegates  at  least 
ten  davs  before  the  special  meeting  is  to  be  held. 
The  notice  shall  specify  the  time  and  place  of  the 
meeting  and  the  purpose  for  which  the  meeting  is 
called.  The  meeting  shall  not  consider  any  busi- 
ness except  that  for  which  it  was  called. 

Section  5.  Delegates. 

A.  Component  Societies.  Each  component  so- 
ciety shall  be  entitled  to  send  to  the  House  of 
Delegates  each  year,  one  delegate  for  each  75 
members,  and  one  for  a major  fraction  thereof; 


for  October,  1970 


329 


but  each  component  society  which  has  made  its 
annual  report  and  paid  its  assessment  as  provided 
for  in  this  Constitution  and  Bylaws,  shall  be  en- 
titled to  one  delegate. 

The  number  of  delegates  to  which  any  com- 
ponent society  is  entitled  shall  be  determined  by 
the  number  of  active  members  of  the  component 
society  on  the  membership  rolls  of  the  Illinois 
State  Medical  Society  as  of  December  31  of  the 
preceding  year. 

The  term  of  office  of  a delegate  shall  begin 
January  1 following  his  election,  and  shall  be  for 
two  years,  or  until  his  successor  has  been  elected. 
Component  societies  with  one  delegate  only,  may 
elect  for  one  year. 

B.  Affiliated  Groups.  The  combined  Illinois 
chapters  of  the  Student  American  Medical  Asso- 
ciation shall  be  considered  a single  affiliate  group. 

{.Representation.  The  Student  American 
. Medical  Association,  as  an  affiliate  group, 
shalt  be  entitled  to  one  delegate  and  one 
alterflate'^delegate  to  serve  in  the  House 
of  Delegates  with  vote. 

2.  Term  of  o//rb^ ' The  term  of  office  of  a 
delegate  shall  begin  January  1,  following 
his  election,  and  shall’  be  for  two  years, 
or  until  his  successor  has  been  elected. 

Section  6.  Registration.  Before  being  seated  at  any 
annual  or  special  session,  each  delegate  or  his 
alternate  shall  deposit  with  the  Reference  Com- 
mittee on  Credentials  a certificate  signed  by  the 
president  and/or  the  secretary  of  the  component 
society,  stating  that  the  delegate  or  alternate  has 
been  regularly  elected  to  the  House  of  Delegates. 

A delegate  or  his  alternate  may  be  seated  with- 
out credentials,  provided  he  is  properly  identified 
and  so  certified  to  the  secretary  of  the  Illinois 
State  Medical  Society. 

Whenever  a delegate  or  his  alternate  are  both 
unable  to  attend  a particular  meeting,  the  com- 
ponent society  may  select  and  certify  a substitute 
delegate  who  shall  have  the  same  powers  and 
duties  as  did  the  delegate. 

A delegate  whose  credentials  have  been  accepted 
by  the  Reference  Committee  on  Credentials  and 
whose  name  has  been  placed  on  the  roll  of  the 
House,  shall  remain  a delegate  until  final  adjourn- 
ment of  that  session.  If  a delegate,  once  seated, 
is  unable  to  be  present  for  reasons  acceptable  to 
the  Committee  on  Credentials,  an  alternate  may  be 
certified  by  that  Committee.  After  the  alternate 
has  been  seated,  he  cannot  be  replaced  for  that 
session. 

Section  7.  AM  A Delegates  and  Alternate  Dele- 
gates. The  House  of  Delegates  shall  elect  repre- 
sentatives to  the  House  of  Delegates  of  the  Ameri- 
can Medical  Association  in  accordance  with  the 
Constitution  and  Bylaws  of  that  body. 

Section  8.  District  Divisions.  The  House  of  Dele- 


gates shall  divide  the  state  into  districts,  specifying 
which  counties  each  district  shall  include. 

Section  9.  Committees.  The  House  of  Delegates 
may  authorize  the  appointment  of  ad  hoc  com- 
mittees by  the  president,  who  shall  first  consult 
with  the  president-elect. 

The  president  shall  have  authority  to  designate 
to  serve  on  ad  hoc  committees,  members  of  the 
Society  who  are  not  members  of  the  House  and 
who  may  be  present  and  permitted  to  participate 
in  the  debate  when  the  report  of  the  committee 
is  considered. 

CHAPTER  IV.  ELECTION  OF  OFFICERS 
Section  1.  Officers.  The  officers  of  this  Society 
shall  consist  of  the  president,  president-elect,  first 
and  second  vice  presidents,  secretary-treasurer, 
speaker  and  vice  speaker,  sixteen  trustees  and  one 
trustee-at-large. 

Section  2.  Elections.  All  elections  shall  be  by 
ballot  except  when  there  is  only  one  candidate  for 
a given  office,  then  election  may  be  by  voice  vote. 

The  majority  of  votes  cast  shall  be  necessary  to 
elect. 

The  election  of  officers,  delegates  and  alternate 
delegates  to  the  AMA,  shall  follow  the  comple- 
tion of  action  on  current  and  old  business  at  the 
final  session  of  the  House  of  Delegates. 

Section  3.  Terms  of  Office.  The  president-elect, 
vice  presidents,  secretary-treasurer,  the  speaker 
and  vice  speaker  shall  be  elected  annually  by  the 
House  of  Delegates  to  serve  for  a term  of  one 
year. 

Members  of  the  Board  of  Trustees  shall  be 
elected  by  the  House  of  Delegates  to  serve  for  a 
term  of  three  years. 

The  speaker  and  vice  speaker  shall  not  be 
elected  for  more  than  three  consecutive  terms  to 
their  respective  offices;  they  shall  be  elected  from 
the  membership  of  the  House  of  Delegates. 

The  president-elect  shall  be  inducted  into  the 
office  of  president  by  the  retiring  president  during 
the  final  session  of  the  House  of  Delegates.  After 
assuming  office  at  the  adjournment  of  the  annual 
business  meeting,  he  shall  continue  in  office  until 
his  successor  has  been  elected  and  installed.  Fol- 
lowing his  retirement  as  president,  he  shall  auto- 
matically become  a trustee-at-large  for  a term  of 
one  year. 

CHAPTER  V.  DUTIES  OF  OFFICERS 
Section  1.  The  President.  The  president  of  the 
Illinois  State  Medical  Society  shall  lead  the  Society 
in  all  its  functions.  He  shall  deliver  an  annual 
address  at  such  time  as  may  be  arranged,  and 
perform  such  other  duties  as  custom  and  parlia- 
mentary usage  may  require. 

The  president  shall  appoint  the  ad  hoc  com- 
mittees of  the  House  of  Delegates.  He  may  seek 
the  advice  of  the  officers  and  trustees. 

He  shall  preside  at  the  general  scientific  meetings 


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of  the  Society  or  designate  one  of  the  vice  presi- 
dents to  substitute  for  him. 

Section  2.  The  Vice  Presidents.  The  vice  presidents 
shall  act  for  and  perform  such  duties  for  the  presi- 
dent as  he  shall  direct.  They  shall,  when  so  act- 
ing, implement  and  advance  the  programs  and  poli- 
cies of  the  president. 

In  the  event  of  the  president’s  death,  resignation 
or  removal  from  office,  the  first  vice  president  shall 
succeed  to  the  presidency. 

In  the  event  of  a vacancy  in  the  office  of  first 
vice  president,  the  president  shall  fill  the  office  by 
appointment. 

Section  3.  Successor  to  President-Elect.  In  the 
case  of  death,  resignation,  or  removal  from  office 
of  the  president-elect,  the  office  shall  be  filled  by 
the  House  of  Delegates  at  the  next  annual  con- 
vention by  election  at  a time  recommended  by  the 
Reference  Committee  on  Rules  and  Order  of 
Business. 

Section  4.  The  Speaker.  The  speaker,  who  shall  be 
versed  in  parliamentary  procedure,  shall  preside  at 
the  meetings  of  the  House  of  Delegates  and  shall 
perform  such  duties  as  custom  and  parliamentary 
usage  require. 

He  shall  appoint  the  reference  committees. 

He  shall  be  an  ex-officio  member  of  the  Com- 
mittee on  Constitution  and  Bylaws. 

Section  5.  The  Vice  Speaker.  The  vice  speaker 
shall  preside  for  the  speaker  in  the  latter’s  absence 
or  at  his  request.  In  case  of  death,  resignation  or 
inability  of  the  speaker  to  perform  his  duties,  the 
vice-speaker  shall  serve  during  the  unexpired  term. 

Section  6.  The  Secretary-Treasurer.  In  addition 
to  the  rights  and  duties  ordinarily  devolving  on 
the  secretary  of  a corporation  by  law,  custom  or 
parliamentary  usage,  and  those  granted  or  im- 
posed in  other  provisions  of  the  Constitution  and 
these  Bylaws,  the  secretary-treasurer  shall  be  the 
official  custodian  of  all  securities  and  the  income 
therefrom,  owned  by  the  Society,  subject  to  the 
direction  and  disposition  of  the  Board  of  Trustees. 
He  shall  be  a member  of  the  Finance  Committee 
of  the  Board  of  Trustees. 

The  Board  of  Trustees  may  select  a bank  or 
trust  company  to  act  as  custodian  in  the  place  of 
the  secretary-treasurer,  of  all  or  any  part  of  such 
securities  and  to  act  as  agent  of  the  Society  in 
collecting  the  income  therefrom. 

He  shall  perform  such  other  duties  as  may 
be  directed  by  the  House  of  Delegates  or  by  the 
Board  of  Trustees. 

In  the  event  of  a vacancy  in  the  office  of  the 
secretary-treasurer,  the  Board  of  Trustees  shall  fill 
the  vacancy  until  the  next  annual  election. 

CHAPTER  VI.  THE  BOARD  OF  TRUSTEES 

Section  1.  Composition.  The  Board  of  Trustees 
shall  consist  of  sixteen  trustees  elected  by  the 


House  of  Delegates  [six  shall  be  chosen  from 
district  number  three,  and  one  from  each  of  the 
other  ten  districts  (see  map  attached),  these  dis- 
tricts of  the  geographical  area  as  of  May,  1946], 
and  one  trustee-at-large  (the  retiring  president, 
who  shall  serve  a term  of  one  year),  the  presi- 
dent, the  president-elect,  the  speaker  and  secre- 
tary-treasurer. 

The  vice  presidents  and  vice  speakers  shall  at- 
tend the  meetings  (including  executive  sessions), 
with  the  right  of  discussion,  but  without  the  right 
to  vote. 

Section  2.  The  duties  of  the  Board  of  Trustees  are 
executive,  custodial  and  judicial. 

A.  Executive  Duties.  The  Board  of  Trustees 
shall  implement  all  mandates  from  the  House 
of  Delegates  except  in  matters  of  property 
or  finance  when  it  shall  have  sole  authority. 

The  Board  of  Trustees  may  request  a re- 
port from  any  committee  in  the  interim  be- 
tween meetings  of  the  House  of  Delegates. 

B.  Custodial  Duties.  The  Board  of  Trustees  shall 
have  charge  and  control  of  all  property  of 
whatsoever  nature  belonging  to  the  Society, 
and  of  all  funds  from  whatsoever  source 
belonging  to  the  Society. 

No  person  shall  expend  or  use  for  any 
purpose  money  belonging  to  the  Society  with- 
out the  approval  of  the  Board  of  Trustees. 

All  money  received  by  the  Board  of  Trus- 
tees and  its  agents,  resulting  from  the  duties 
assigned  them,  shall  be  paid  into  the  treasury 
of  the  Society,  and  all  orders  on  the  treasury 
for  disbursement  of  money  shall  be  approved 
by  the  Board. 

The  Board  of  Trustees  shall  formulate  rules 
governing  the  expenditure  of  money  to  meet 
the  necessary  running  expenses  and  fixed 
charges  of  the  Society. 

All  acts  of  the  House  of  Delegates  in- 
volving the  expenditure,  appropriation  or  use 
in  any  manner  of  money,  or  the  acquisition 
or  disposal  in  any  manner  of  property  of  any 
kind  belonging  to  the  Society,  must  be  up- 
proved  by  the  Board  of  Trustees  before  same 
shall  become  effective. 

Funds  may  be  appropriated  to  encourage 
scientific  investigation,  medical  education  or 
any  other  purpose  deemed  proper  and  ap- 
proved by  the  Board  of  Trustees. 

C.  .Judicial  Duties.  The  Board  of  Trustees  shall 
be  the  board  of  censors  of  the  Society.  It 
shall  have  jurisdiction  over  all  questions  of 
ethics  and  in  the  interpretation  of  the  laws 
of  the  Society.  It  shall  consider  all  questions 
involving  the  rights  and  standing  of  members, 
whether  in  relation  to  other  members,  to 
component  societies,  or  to  this  Society. 

All  questions  of  an  ethical  nature  before 
the  House  of  Delegates  or  the  general  scien- 
tific meetings,  shall  be  referred  to  the  Board 


for  October,  1970 


331 


of  Trustees  without  discussion.  The  Board 
shall  hear  and  decide  all  questions  of  pro- 
cedure affecting  the  conduct  of  members  on 
which  an  appeal  is  taken  from  the  decision 
of  a component  society. 

The  decision  of  the  Board  of  Trustees  shall 
be  final  except  that  an  appeal  may  be  taken 
by  a member  charged  with  misconduct  as 
provided  for  in  the  Constitution  and  Bylaws 
of  the  American  Medical  Association. 

Section  3.  Executive  Administrator.  The  Board  of 
Trustees  shall  employ  an  executive  administrator 
(who,  when  he  shall  be  a physician,  may  be 
designated  as  the  executive  vice-president)  whose 
duties  shall  be  determined  by  the  Board.  He 
shall  be  responsible  to  the  chairman  of  the  Board. 
The  Board  shall  review  at  each  of  its  meetings 
the  interim  activities  of  the  administrator.  The 
Board  shall  also  employ  such  other  people  as  are 
needed  for  the  conduct  of  the  affairs  of  the  Society. 

Section  4.  Meetings.  The  Board  of  Trustees  shall 
meet  daily  during  the  annual  convention  of  the 
Society,  and  at  such  other  times  as  necessity  may 
require,  subject  to  the  call  of  the  chairman,  or  on 
the  petition  of  the  majority  of  the  Trustees. 

Section  5.  Organization. 

A.  Chairman.  The  Board  of  Trustees  shall  meet 
on  the  last  day  of  the  annual  convention  and 
elect  from  among  its  members  a chairman. 
He  shall  hold  office  for  one  year  and  may 
succeed  himself  for  one  additional  year. 

B.  Duties  of  the  Chairman.  The  chairman  of  the 
Board  of  Trustees  shall  prepare  an  agenda 
and  shall  preside  at  all  meetings  of  the  Board. 
He  shall  make  an  annual  report  to  the  House 
of  Delegates.  He  shall  be  chairman  of  the 
Executive  Committee.  He  shall  present  the 
report  of  the  actions  of  the  Executive  Com- 
mittee to  the  Board. 

Section  6.  Quorum.  Ten  members  of  the  Board  of 
Trustees  shall  constitute  a quorum  for  the  trans- 
action of  business. 

Section  7.  County  Societies.  The  Board  of  Trustees 
shall  have  authority  to  organize  the  physicians 
of  two  or  more  counties  into  societies  to  be 
suitably  designated,  and  these  societies,  when  or- 
ganized and  chartered,  shall  be  entitled  to  all 
rights  and  privileges  provided  for  component  so- 
cieties until  such  counties  shall  be  organized  sep- 
arately. 

Section  8.  Publications.  The  Board  of  Trustees 
shall  provide  and  superintend  the  publication  and 
the  distribution  of  all  proceedings,  transactions  and 
memoirs  of  the  Society,  and  shall  have  authority 
to  appoint  an  editor  and  such  assistants  as  it  deems 
necessary. 

Section  9.  Bonding.  The  Board  of  Trustees  shall 
provide  at  the  expense  of  the  Society,  adequate 


bond  for  those  officers  and  employees  of  the 
Society  it  considers  require  bonding. 

Section  10.  Duties  of  Trustees.  Each  trustee  shall 
be  the  organizer,  consultant,  advisor,  administrator 
and  speaker  for  the  members  of  his  district,  and 
represent  the  Society  as  well  as  the  members  of  his 
district  at  the  Board  meetings. 

Each  trustee  should  visit  the  societies  in  his 
district  at  least  once  a year.  He  shall  make  an 
annual  report  of  his  work  and  the  condition  of  the 
profession  in  each  society  in  his  district  to  the 
Board  of  Trustees  and  to  the  House  of  Delegates. 

Where  his  district  is  composed  of  more  than 
one  county,  the  trustee  shall  be  an  ex-officio  mem- 
ber of  the  district  Ethical  Relations  Committee, 
Grievance  Committee,  and  Prepayment  Plans  and 
Organizations  Committee.  He  shall  report  to  the 
Board  of  Trustees  the  actions  of  the  component 
societies  on  reports  of  these  committees. 

The  necessary  traveling  expenses  incurred  by 
such  trustee  in  the  line  of  the  duties  herein  im- 
posed, may  be  allowed  by  the  Board  of  Trustees 
upon  presentation  of  a properly  itemized  state- 
ment. 

Section  11.  Vacancies.  If  during  the  interval  be- 
tween two  annual  conventions,  sickness,  death,  or 
removal  from  the  state  or  district,  or  any  other 
reason  prevents  a trustee  from  attending  the 
duties  of  his  district,  or  if  he  shall  be  absent  from 
two  consecutive  meetings  of  the  Board,  his  office 
may  be  declared  vacant  at  the  discretion  of  the 
Board.  The  Board  shall  have  the  authority  to  fill 
the  vacancy  for  the  period  between  the  date  at 
which  the  office  was  declared  vacant  and  the  next 
annual  meeting  of  the  House  of  Delegates. 

Section  12.  The  Benevolence  Fund.  Each  year  the 
Board  shall  appropriate  from  the  funds  of  this 
Society  such  sum  or  sums  as  it  may  deem  proper 
to  be  held  in  a fund  to  be  known  as  “The  Benevo- 
lence Fund.”  This  fund  is  established  and  shall  be 
used  only  for  the  assistance  or  relief  of  needy 
members  of  this  Society,  their  widows,  widowers, 
or  minor  children.  The  assets  shall  be  held  in  the 
treasury  of  this  Society  in  a separate  fund.  Dona- 
tions or  bequests  to  the  Benevolence  Fund  auto- 
matically become  a part  of  these  assets. 

Section  13.  Audit  and  Financial  Statement.  The 
Board  of  Trustees  shall  employ  annually  a certi- 
fied public  accountant  to  audit  all  accounts  of  the 
Society,  and  present  a statement  of  same  in  its 
annual  report  to  the  House  of  Delegates. 

This  report  shall  also  specify  the  character  and 
cost  of  all  publications  of  the  Society  during  the 
year,  and  the  amount  of  all  other  property  be- 
longing to  the  Society  under  its  control,  with  such 
suggestions  as  it  may  deem  necessary. 

CHAPTER  VII.  DISTRICT  COMMITTEES 
Each  trustee  district  which  is  composed  of  more 
than  one  county,  shall  have  an  Ethical  Relations 


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Committee,  a Peer  Review  Committee,  and  such 
other  committees  as  required  to  provide  to  each 
component  society,  those  services  the  component 
society  may  not  be  able  to  provide  for  itself.  Dis- 
trict committees  shall  function  only  at  the  request 
of  a component  society  within  the  district. 

Complaints  initially  received  by  district  com- 
mittees shall  be  referred  immediately  to  the  com- 
ponent society  for  action. 

District  committees  shall  be  governed  by  the 
procedural  rules  and  regulations  governing  the 
counterpart  state  society  committee  or  by  these 
Bylaws. 

Reports  of  findings  and  recommendations  of  these 
district  committees  shall  be  made  to  the  compon- 
ent society  which  requested  action. 

The  district  trustee  shall  include  a summary 
of  the  activities  of  each  of  these  committees  and 
the  findings  in  general,  in  his  annual  report  to  the 
House  of  Delegates. 

The  committee  members  shall  be  elected  at  a 
meeting  of  the  delegates  of  the  district  called 
by  the  trustee  of  the  district,  before  or  during 
the  annual  convention  of  the  Illinois  State 
Medical  Society.  Chairmen  of  the  committees 
shall  be  designated  by  the  trustee  of  the  dis- 
trict, and  the  trustee  shall  be  an  ex-officio  mem- 
ber of  each  committee. 

CHAPTER  VIII.  DUES  AND  EXPENSES 

Section  1.  Annual  Dues.  Assessments  may  be 
levied  by  the  House  of  Delegates  on  each  com- 
ponent society  on  a proportional  basis.  The  amount 
of  the  dues  shall  be  fixed  by  the  House  of  Dele- 
gates and  shall  include  the  dues  and/or  assess- 
ments approved  by  the  House  of  Delegates  of 
the  American  Medical  Association. 

These  annual  dues  shall  include  the  annual  sub- 
scription to  the  Illinois  Medical  Journal  which 
shall  be  at  least  fifty  per  cent  of  the  regular  sub- 
scription price  of  the  Journal. 

Section  2.  The  Board  of  Trustees  upon  recom- 
mendation of  the  component  society,  shall  give 
50%  reduction  in  dues  to  teaching,  research  and 
administrative  personnel  in  full  time  employment 
in  the  approved  medical  schools  in  Illinois,  or 
similar  not-for-profit  institutions  in  Illinois. 

Section  3.  Physicians  in  private  practice  of  medi- 
cine may  be  given  a 50%  reduction  in  dues  during 
the  first  year  of  practice  upon  recommendation  of 
their  component  society. 

Section  4.  Physicians  approved  for  membership 
after  June  30  shall  pay  one-half  of  the  annual  dues 
for  that  year. 

Section  5.  The  Board  of  Trustees  may  authorize 
the  remission  of  dues  of  any  member  on  recom- 
mendation of  his  component  society  for  good  rea- 
son. In  such  cases  the  secretary  shall  recommend 


remission  of  dues  by  the  American  Medical  Asso-' 
ciation. 

CHAPTER  IX.  COMMITTEES 
Part  1.  Councils  and  Committees 
Section  1.  Councils  and  Committees 

The  councils  and  committees  of  the  Illinois 

State  Medical  Society  shall  be: 

A.  Councils  (Standing  committees) 

B.  Reference  committees  of  the  House  of 

Delegates 

C.  Board  of  Trustees  committees 

Section  2.  The  appointing  authority  may  alter 

council  and/or  committee  membership  and  as- 
sign or  delete  duties  as  it  deems  necessary. 

Part  2.  Councils. 

Section  1.  The  Councils  of  the  Society  shall  be: 

A.  Medical-Legal  Council 

B.  Council  on  Legislation  & Public  Affairs 

C.  Council  on  Education  and  Manpower 

D.  Council  on  Economics  and  Peer  Review 

E.  Council  on  Environmental  and  Community 
Health 

F.  Council  on  Public  Relations  and  Member- 
ship Services 

G.  Council  on  Mental  Health  and  Addiction 

H.  Council  on  Social  and  Medical  Services; 
and  such  other  Councils  as  may  be  established 
from  time  to  time  by  the  Board  of  Trustees. 

Section  2.  Organization  of  Councils. 

A.  Councils  shall  be  appointed  by  the  Board  of 
Trustees. 

B.  The  chairman  of  a Council  shall  be  desig- 
nated by  the  Board.  He  may  not  serve  as 
chairman  of  any  committee  of  the  Council. 

C.  Each  Council  shall  have  authority  to  request 
the  Board  of  Trustees  to  appoint  sub-com- 
mittees for  any  purpose  within  the  functions 
of  the  Council.  A member  of  the  Council 
shall  be  designated  as  chairman  of  the  sub- 
committee. 

D.  Only  active  members  of  the  Illinois  State 
Medical  Society  (who  are  not  voting  mem- 
bers of  the  Board  of  Trustees)  may  be  ap- 
pointed to  serve  as  chairmen  or  members  of 
any  council  or  committee.  Voting  members 
of  the  Board  of  Trustees  may  serve  as  advi- 
sory members  to  any  council  or  committee. 

Recommendations  for  membership  on  any 
committee  may  be  submitted  to  the  Board  of 
Trustees  by  the  House  of  Delegates,  or  in 
writing  by  any  member  of  the  Society. 

A state  committee  which  reviews  the  de- 
cisions of  a similar  committee  of  a compon- 
ent society  may  not  have  as  a member  one 
who  currently  serves  on  the  same  committee 
of  a component  society  or  district. 


for  October,  1970 


333 


E.  Each  Council,  sub-committee  or  special 
committee  shall  have  authority  to  make  rules 
to  govern  its  procedures  subject  to: 

(1)  Specific  requirements  of  the  Constitu- 
tion and  Bylaws  and  the  policies  of  the 
House  of  Delegates,  and 

(2)  Approval  of  the  Board  of  Trustees. 

F.  Each  Council  shall  submit  for  adoption,  a 
budget  for  the  ensuing  year,  and  the  Board 
of  Trustees  shall  determine  the  appropriation 
for  each  Council.  Requests  for  additional 
funds  must  be  approved  by  the  Board  be- 
fore they  are  committed. 

G.  The  president  of  the  Society,  the  speaker 
of  the  House  and  the  chairman  of  the  Board 
shall  be  ex-officio  members  without  vote  of 
the  various  Councils,  and  may  attend  all 
committee  meetings. 

H.  Each  Council  shall  have  members  in  suf- 
ficient quantity  so  that  each  sub-committee 
may  be  chaired  by  a different  member. 

I.  Terms  of  office  of  members  of  the  Councils 
shall  not  be  more  than  three  years,  but  may 
be  terminated  at  any  time  at  the  discretion 
of  the  Board.  No  member  of  a Council  shall 
serve  more  than  three  consecutive  terms. 
Service  of  two  or  more  years  in  an  unex- 
pired term  shall  be  considered  a full  term. 

J.  Reports. 

(1)  Special  committee  reports  shall  be 
made  by  the  chairman  to  the  sub- 
committee from  which  he  was  ap- 
pointed. 

(2)  Reports  from  sub-committees  (which 
shall  contain  summaries  of  the  report 
of  special  committees)  shall  be  made 
by  the  chairman  to  the  Council  of 
which  he  is  a member. 

(3)  Reports  of  Council  activities  shall  in- 
clude recommendations  on  reports  and 
requests  from  sub-committees,  and 
shall  be  made  to  the  Board  of  Trus- 
tees by  the  chairman  of  the  Council. 

(4)  The  Chairman  of  the  Council  with  the 
approval  of  the  Board,  may  permit  any 
member  of  a committee  under  the 
Council  to  clarify  the  report  of  that 
committee  to  the  Board. 

(5)  The  Chairman  of  any  committee  may 
request  the  Board  of  Trustees  to  allow 
him,  or  any  member  of  his  committee, 
to  appear  before  the  Board. 

(6)  All  councils  shall  submit  to  the 
House  of  Delegates,  written  reports 
summarizing  all  actions,  and  may  in- 
clude recommendations  for  House  con- 
sideration. 

K.  Vacancies  on  any  committee  may  be  filled  at 
any  time  by  the  Board  of  Trustees.  Com- 


mittee membership  may  be  enlarged  or  de- 
creased or  the  committee  may  be  discharged 
by  the  Board  of  Trustees. 

L.  Committee  Meetings 

The  chairman  of  a committee,  when  he  con- 
siders it  expedient  and  with  the  consent  of 
two  thirds  of  the  members  of  the  committee, 
may  conduct  business  or  hold  meetings  by 
mail  or  by  conference  call,  provided  all 
members  of  the  committee  are  given  oppor- 
tunity to  participate,  that  minutes  of  the 
transactions  are  recorded,  approved  by  mem- 
bers participating,  and  circulated  among  all 
committee  members. 

Section  4.  Duties  (Area  of  Concern) 

A.  The  Medical-Legal  Council  shall  be  con- 
cerned in  the  areas  of: 

1.  Liaison  with  the  Illinois  Bar  Association 

2.  Liaison  with  courts,  particularly  where 
improper  medical  testimony  is  involved 

3.  Implementation  of  the  Impartial  Medi- 
cal Testimony  Rule 

4.  Legal  aspects  of  medical  practice  other 
than  in  the  area  of  mental  health 

5.  Licensing  and  standards  of  practice 

6.  Quackery 

7.  Anatomical  gifts  and  organ  transplants 

B.  The  Council  on  Legislation  and  Public  Affairs 
shall  be  concerned  in  areas  of: 

1.  Federal  and  state  legislation — analysis 
and  communication 

2.  Legislative  liaison — both  state  and  fed- 
eral 

3.  Political  education 

C.  The  Council  on  Education  and  Manpower 
shall  be  concerned  in  the  areas  of: 

1.  Liaison  with  medical  schools,  curricula, 
etc. 

2.  Health  manpower  and  training 

3.  Postgraduate  education 

4.  Internships,  residencies,  etc. 

5.  Scientific  assembly 

6.  Student  loans 

7.  Liaison  with  Student  American  Medical 
Association 

8.  Continuing  Medical  Education 

D.  The  Council  on  Economics  and  Peer  Review 
shall  be  concerned  in  the  areas  of: 

1.  Relations  with  governmental  purchase  of 
care  programs  (Medicare,  Medicaid,  Vo- 
cational Rehabilitation,  etc.) 

2.  Relations  with  prepayment,  insurance 
and  other  third  party  plans 

3.  Fees  and  fee  adjudication  as  promulgated 
by  the  Usual  and  Customary  Fee  Com- 
mittee 

4.  Health  care  cost  and  utilization 

5.  Peer  Review 

E.  Council  on  Environmental  and  Community 
Health  shall  be  concerned  in  the  areas  of: 


334 


Illinois  Medical  Journal 


^ 1.  Governmental  administrative  regulation 

— Departments  of  Health 

Y 2.  Public  Safety 

3.  Occupational  Health 

4.  Child  and  School  Health 
■ 5.  Pollution 

6.  Nutrition 

F.  Council  on  Public  Relations  and  Member- 
ship Services  shall  be  concerned  in  the  areas 
of: 

1.  Publicity  and  promotion 

2.  Media  relations 

3.  Exhibits  and  public  service  progranuning 

4.  Religion  and  medicine 

5.  Illinois  State  Medical  Society  sponsored 
membership  insurance  programs 

6.  New  member  orientation  and  member- 
ship benefit  explanation 

7.  Fifty  Year  Club 

G.  Council  on  Mental  Health  and  Addiction 
shall  be  concerned  in  the  areas  of: 

1.  Facilities  and  services 

2.  Liaison  with  Department  of  Mental 
Health 

3.  Legal  aspects  of  commitment,  etc. 

4.  Narcotics  and  dangerous  drugs 

5.  Alcoholism 

H.  Council  on  Social  and  Medical  Services  shall 
be  concerned  in  the  areas  of: 

1.  Health  care  facilities  and  services 

2.  Emergency  and  disaster  care 

3.  Liaison  with  other  health  professional 
and  health  oriented  organizations 

4.  Relations  with  specialists  not  otherwise 
assigned 

5.  Problems  of  aging 

6.  Rural  Health 

Section  5.  Reference  Committees 

Reference  Committees  shall  be  appointed  by 
the  speaker  of  the  House  of  Delegates  as  out- 
lined in  Chapter  X.  REFERENCE  COM- 
MITTEES, and  as  provided  therein. 

Part  3.  House  of  Delegates  Committees. 

SECTION  I.  Committees 

A.  Appointment.  Immediately  after  the  or- 
ganization of  the  House  of  Delegates  at  each 
annual  or  special  meeting,  the  speaker  shall 
announce  the  appointment  from  among  the 
members  of  the  House,  such  committees  as 
may  be  deemed  expedient  by  the  House  of 
Delegates. 

Each  committee  shall  consist  of  five  or 
more  members  unless  otherwise  provided, 
the  chairman  to  be  announced  by  the  speak- 
er. These  committees  shall  serve  during  the 
meeting  at  which  they  are  appointed. 

B.  Duties  of  Reference  Committees.  Referen- 
ces, resolutions,  measures  and  propositions 
presented  to  the  House  of  Delegates  shall 
be  referred  to  the  appropriate  committee, 
which  shall  report  to  the  House  of  Dele- 


gates before  final  action  shall  be  taken.  A 
two-thirds  affirmative  vote  of  the  House  of 
Delegates  shall  be  required  to  suspend  this 
rule. 

C.  Organization.  Each  reference  committee  shall, 
as  soon  as  possible  after  the  adjournment  of 
each  session,  or  during  the  session  if  neces- 
sary, take  up  and  consider  such  business  as 
may  have  been  referred  to  it,  and  shall  re- 
port on  same  at  the  next  session,  or  when 
called  upon  to  do  so. 

D.  Reference  Committees.  The  following  com- 
mittees are  hereby  provided  for: 

A Committee  on  Credentials 

A Committee  on  Rules  and  Order  of  Busi- 
ness 

Tellers  and  Sergeants-at-Arms 

A Committee  on  Changes  in  the  Constitu- 
tion and  Bylaws 

and  such  other  reference  committees  as  the 
speaker  shall  deem  necessary  to  conduct  the 
business  of  the  House,  or  consider  the  re- 
ports of  officers,  trustees,  executive  admin- 
istrator, the  reports  of  committees  pertain- 
ing to  administrative  activities,  economics 
activities,  scientific  activities,  public  relations 
activities  and  legislative  activities,  as  well  as 
such  resolutions,  reports,  and  proposals  as 
shall  be  brought  before  the  House  of  Dele- 
gates. 

E.  The  Committee  on  Credentials  shall  con- 
sider all  questions  regarding  the  registration 
and  the  credentials  of  the  delegates.  It  shall 
pass  out  and  receive  the  attendance  slips  for 
each  session  of  the  House  of  Delegates,  and 
perform  any  other  duties  assigned. 

F.  A Committee  on  Rules  and  Order  of  Business 
shall  consider  all  matters  regarding  rules 
governing  action,  method  of  procedure  and 
order  of  business  for  the  House  of  Delegates. 

G.  The  Tellers  and  Sergeants-at-Arms  shall 

1.  Serve  the  speaker  of  the  House  of  Dele- 
gates 

2.  Distribute,  collect  and  tally  votes  when  a 
ballot  is  taken,  or  a numerical  tally  is 
required. 

3.  Certify  those  in  attendance  in  closed  or 
executive  sessions  of  the  House  of  Dele- 
gates. 

H.  The  Committee  on  Changes  in  Constitution 
and  Bylaws  shall  consider  all  proposed 
amendments  to  the  Constitution  and  Bylaws. 

The  chairman  of  the  Committee  on  Con- 
stitution and  Bylaws,  or  his  representative, 
shall  serve  in  an  advisory  capacity  to  this 
reference  committee  and  shall  attend  all  ses- 
sions, including  the  executive  sessions  of  the 
reference  committee,  to  assist  in  the  prepara- 
tion of  the  report  of  the  committee  to  the 
House  of  Delegates. 


for  October,  1970 


335 


Section  2.  Ad  hoc  Committees 

A.  Ad  hoc  committees  shall  be  appointed  by  the 
speaker  of  the  House  of  Delegates  to  accom- 
plish specific  duties. 

B.  Any  member  of  the  Society  may  be  asked  to 
serve. 

C.  The  terms  of  appointment  shall  be  for  the 
duration  of  the  task,  or  until  the  committee 
shall  be  discharged. 

D.  Ad  hoc  committees  expected  to  serve  for 
more  than  three  years,  shall  be  reorganized 
and  given  the  status  of  a sub-committee  or 
special  committee  under  the  appropriate 
Council  and  should  be  appointed  by  the 
Board  of  Trustees. 

E.  Between  meetings  of  the  House  of  Delegates 
ad  hoc  committees  shall  report  to  the  Board 
of  Trustees  keeping  it  informed  of  all  current 
activities. 

Part  4.  Committees 

Section  1.  Board  of  Trustees  Committees. 

The  Board  shall  form  the  following  com- 
mittees within  itself: 

A.  Executive  Committee 

B.  Finance  Committee 

C.  Policy  Committee 

D.  Ethical  Relations  Committee 

E.  Committee  on  Committees 

F.  Committee  on  Constitution  and  Bylaws 

G.  Committee  on  Publications 

H.  Advisory  Committee  to  the  Woman’s 
Auxiliary,  and 

such  others  as  deemed  necessary. 

Section  2.  Duties  of  the  Committees. 

A.  Executive  Committee.  The  Executive  Com- 
mittee shall  consist  of  the  president,  the 
president-elect,  the  chairman  of  the  Board, 
the  chairman  of  the  Finance  Committee,  the 
chairman  of  the  Policy  Committee,  the  sec- 
retary-treasurer, the  trustee-at-large  and  the 
immediate  past  chairman  of  the  Board,  pro- 
vided he  is  still  a Trustee. 

It  may  be  given  authority  to  act  by  the 
Board  of  Trustees. 

In  matters  of  routine  administration,  spe- 
cial plans,  policy,  endorsement  or  expendi- 
ture it  shall  report  to  and  request  approval 
of  the  Board.  It  shall  receive  the  reports  of 
the  Finance  and  Policy  Committees  and  make 
recommendations  concerning  them  to  the 
Board.  It  shall  furnish  a report  of  its  ac- 
tions to  the  Board  at  each  meeting. 

B.  Finance  Committee.  The  Finance  Committee 
shall  consist  of  the  secretary-treasurer  of  the 
Society  and  three  members  of  the  Board  ap- 
pointed by  the  chairman.  It  shall  develop  for 
approval  of  the  Board  through  the  Execu- 
tive Committee,  a budget  for  the  fiscal  year. 
It  shall  supervise  the  financial  transactions 
of  the  Society.  It  shall  make  recommenda- 


tions to  the  Board  for  the  control  and  in^ 
vestment  of  the  funds  of  the  Illinois  State 
Medical  Society. 

The  Medical  Benevolence  Committee  shall 
be  a subcommittee  of  the  Finance  Commit- 
tee. It  shall: 

1.  Examine  applications  to  the  Society  for 
assistance  to  determine  eligibility  for  as- 
sistance. 

2.  Keep  the  names  of  the  beneficiaries  con- 
fidential and  known  only  to  the  com- 
mittee. 

3.  Recommend  to  the  Finance  Committee 
the  allotment  for  each  recipient,  and 

4.  If  funds  available  become  inadequate  to 
meet  disbursements,  request  the  Board 
of  Trustees  to  appropriate  sufficient 
funds  to  support  the  program  until  the 
next  budget  appropriation. 

C.  Policy  Committee.  The  Policy  Committee 
shall  consist  of  three  members  of  the  Board 
appointed  by  the  chairman.  It  shall  con- 
tinually review  past  and  current  proceedings 
of  the  House  of  Delegates  to  determine  the 
established  policies  of  the  Illinois  State 
Medical  Society.  It  shall  make  recommenda- 
tions for  future  policy  by  Board  resolution 
to  the  House  of  Delegates. 

D.  The  Ethical  Relations  Committee.  The 
Ethical  Relations  Committee  shall  be  con- 
stituted and  function  as  stipulated  in  Chap- 
ter XI.  Discipline.  Part  2 Illinois  State 
Medical  Society  procedures. 

E.  The  Committee  on  Committees.  The  Com- 
mittee on  Committees  shall  consist  of  three 
members  of  the  Board  appointed  by  the 
chairman.  It  shall  serve  to  review  the  pur- 
poses, activities  and  structure  of  any  coun- 
cils or  committees  at  the  request  of  the 
Board.  The  committee  shall  recommend  such 
changes  in  existing  councils  or  committees 
as  required  to  maintain  the  efficient  opera- 
tion of  the  affairs  of  the  Society. 

The  activities  and  reports  of  the  Commit- 
tee on  Committees  shall  be  reviewed  by  the 
Executive  Committee  and  approved  by  the 
Board  of  Trustees. 

F.  The  Committee  on  Constitution  and  Bylaws. 
The  Committee  on  Constitution  and  Bylaws 
shall: 

1.  Receive  from  individual  members, 
county  societies,  committees,  the  Board 
of  Trustees,  and  the  House  of  Delegates, 
all  suggestions  and  proposals  for  modi- 
fication of  the  Constitution  and  Bylaws; 

2.  Prepare  for  the  consideration  of  the 
House  of  Delegates,  all  changes  in  the 
Constitution  and  Bylaws;  and 

3.  Maintain  constant  surveillance  of  both 
documents  to  keep  them  current,  effective 


336 


Illinois  Medical  Journal 


and  consistent  with  the  policies  of  the 
House  of  Delegates. 

G.  The  Committee  on  Publications.  The  Com- 
mittee on  Publications  shall  be  composed  of 
members  of  the  Board  of  Trustees,  and  shall 
be  responsible  for  the  production  of  the 
Illinois  Medical  Journal. 

It  shall  recommend  to  the  Board  of  Trus- 
tees all  policies  governing  the  editorial,  busi- 
ness and  production  aspects  of  the  Journal. 
It  shall  supervise  the  editor  in  the  selection 
and  preparation  of  all  copy,  and  it  shall  es- 
tablish standards  for  the  editorial  content. 

It  shall  establish  advertising  policies,  rates, 
standards,  and  shall  review  all  new  accounts 
prior  to  acceptance,  and  shall  approve  re- 
print and  circulation  policies. 

It  shall  conduct  a periodic  review  of  the 
printer’s  contract  and  solicit  bids  as  indi- 
cated. It  shall  establish  the  format,  cover, 
type  faces  and  general  layout  of  the  Journal. 

It  shall  review,  edit  and  supervise  the  pub- 
lication of  other  materials  as  directed  by  the 
Board  of  Trustees. 

H.  Advisory  Committee  to  the  Woman’s  Auxi- 
liary. The  Advisory  Committee  to  the 
Woman’s  Auxiliary  shall  consist  of  the  presi- 
dent elect  as  chairman,  the  president  and  the 
chairman  of  the  Board  of  Trustees. 

The  Committee  shall  provide  advice  and 
assistance  to  the  president  of  the  Woman’s 
Auxiliary  in  her  program  for  the  year,  and 
shall  assist  her  in  interpreting  the  activities 
of  the  Illinois  State  Medical  Society. 

CHAPTER  X.  COUNTY  SOCIETIES 

Section  1.  All  county  societies  now  in  affiliation 
with  this  Society,  or  those  which  may  hereafter  be 
organized  in  this  state,  which  have  adopted  princi- 
ples of  organization  in  harmony  with  this  Consti- 
tution and  Bylaws,  shall  upon  application  to  and 
approval  by  the  Board  of  Trustees,  receive  a 
charter  from  and  thereby  become  a component 
part  of  this  Society,  and  members  thereof  shall 
become  members  of  this  Society  and  the  American 
Medical  Association. 

Section  2.  Charters  shall  be  issued  only  on  ap- 
proval of  the  Board,  and  shall  be  signed  by  the 
president  and  the  secretary  of  this  Society. 

The  Board  shall  have  authority  to  revoke  the 
charter  of  any  component  society  whose  actions 
are  in  conflict  with  the  letter  and  spirit  of  this 
Constitution  and  Bylaws. 

Section  3.  Only  one  component  medical  society 
shall  be  chartered  in  any  county. 

Section  4.  Every  registered  physician  holding  the 
title  of  Doctor  of  Medicine  or  its  equivalent,  who 
either  (1)  resides  in  the  jurisdiction  of  a com- 
ponent society,  or  (2)  resides  in  a state  other  than 
Illinois  but  practices  principally  in  the  jurisdiction 


of  a component  society  and  who  is  of  good  moral 
character  and  professional  standing,  shall  be 
eligible  to  membership  in  that  component  society. 

The  component  county  society  shall  be  the  sole 
judge  of  the  qualifications  of  its  members,  subject 
only  to  the  stipulations  contained  in  the  Constitu- 
tion and  Bylaws. 

Section  5.  Any  physician  who  has  been  disciplined 
by  any  action  of  a component  society  and  believes 
he  has  not  had  a fair  trial,  shall  have  the  right  of 
appeal  to  the  Board  of  Trustees. 

Section  6.  When  a member  in  good  standing  in  a 
component  society  changes  his  residence  to  an- 
other county  in  this  state,  such  change  of  residence 
shall  terminate  his  membership  in  such  component 
society.  (This  ruling  shall  not  apply  to  members 
in  military  service  or  in  the  service  of  the  State 
or  the  United  States  government.) 

Such  member  shall  be  entitled,  upon  his  request, 
to  a statement  from  his  former  secretary  as  to  his 
standing.  This  statement  of  standing  shall  be 
issued  without  cost  to  the  applicant. 

He  shall  present  this  statement  to  the  compo- 
nent society  of  the  county  to  which  he  removes 
and  it  shall  accompany  his  application  for  mem- 
bership. The  board  of  censors  of  the  society  receiv- 
ing this  application  shall  give  this  statement  of 
prior  standing  due  consideration  before  accepting 
or  rejecting  his  application  for  membership. 

Section  7.  A physician  living  on  or  near  a county 
line,  or  practicing  partly  or  totally  in  an  adjacent 
county,  may  hold  his  membership  in  the  county 
most  convenient  for  him,  provided  he  submits 
written  authorization  to  that  society  from  the 
component  society  in  whose  jurisdiction  he  resides. 

Section  8.  The  secretary  of  each  component  so- 
ciety shall  keep  a roster  of  its  members,  in  which 
shall  be  shown  the  full  name,  address,  college  and 
date  of  graduation,  date  of  license  to  practice  in 
this  state,  and  such  other  information  as  may  be 
deemed  necessary.  In  keeping  such  a roster  the 
secretary  shall  note  any  changes  in  the  personnel 
of  the  profession  by  death  or  by  removal  to  or 
from  the  county.  When  requested,  he  shall  fur- 
nish on  blanks  supplied  him  for  the  purpose,  an 
official  report  containing  such  information  for  the 
secretary  of  this  Society  and  likewise  for  the 
trustee  of  the  district  in  which  his  county  is 
situated. 

Section  9.  The  secretary  of  each  component  society 
shall  forward  its  roster  of  officers  and  members, 
and  a list  of  delegates  and  alternate  delegates  to 
the  secretary  of  this  Society  before  the  fifteenth  of 
January  each  year. 

Section  10.  Any  component  society  which  fails  to 
pay  its  assessment  or  make  the  annual  report  re- 
quired on  or  before  March  fifteenth  shall  be  held 
as  suspended  and  none  of  its  members  shall  be  per- 
mitted to  participate  in  any  of  the  business  or 


for  October,  1970 


337 


proceedings  of  the  Society  or  of  the  House  of 
Delegates  until  such  requirements  have  been  met. 

A member  is  in  good  standing  unless  otherwise 
disqualified,  whose  dues  are  paid  on  or  before  the 
first  day  of  March  of  the  current  year.  Immediate- 
ly after  the  first  of  March,  each  delinquent  mem- 
ber shall  be  notified  that  in  consequence  of  non- 
payment of  dues,  his  membership  is  delinquent. 
If  dues  remain  unpaid  as  of  June  thirtieth  of  the 
current  year,  membership  shall  be  dropped  auto- 
matically. The  member  may  be  reinstated  by  pay- 
ing all  delinquent  dues,  provided,  in  the  interim, 
he  has  not  been  guilty  of  conduct  prejudicial  to 
membership;  but  if  two  or  more  years  have  elapsed 
since  he  was  a member  in  good  standing,  he  must 
in  addition,  make  application  as  a new  member. 

Section  11.  The  Constitution  and  Bylaws  of  the 
Illinois  State  Medical  Society  and  of  the  American 
Medical  Association,  together  with  the  Principles 
of  Medical  Ethics  of  the  American  Medical  Asso- 
ciation, shall  be  binding  upon  the  members  of  the 
component  societies. 

CHAPTER  XI.  DISCIPLINE 
PART  1.  COMPONENT  SOCIETY 
PROCEDURE 

Section  1.  Local  Ethical  Relations  Committee. 
Each  component  society  may  have,  either  by  ap- 
pointment or  election,  an  Ethical  Relations  Com- 
mittee, whose  duty  it  shall  be  to  prosecute  formal 
charges  of  unethical  conduct.  In  the  event  that  the 
county  society  does  not  have  such  a committee, 
the  district  Ethical  Relations  Committee  shall 
function  in  its  behalf. 

All  parties  may  have  legal  counsel  present  to 
advise  and  counsel  them  during  the  proceedings, 
but  such  counsel  may  not  participate  in  the 
proceedings,  and  may  be  excluded  from  the  hear- 
ing by  the  chairman  or  by  vote  of  the  committee. 

The  component  society  Ethical  Relations  Com- 
mittee may  establish  reasonable  rules  of  procedure, 
and  they  shall  not  be  bound  by  the  technical  rules 
of  evidence  as  the  same  pertain  in  courts  of  law. 
In  all  proceedings  before  such  Ethical  Relations 
Committees,  the  complainant,  the  accused  and  all 
witnesses  before  the  committee  shall  be  placed 
under  oath. 

The  Committee  shall  evaluate  acts  by  the  stand- 
ards established  by  the  House  of  Delegates  of  the 
American  Medical  Association  (specifically  known 
as  the  Principles  of  Medical  Ethics  of  the 
American  Medical  Association),  and  by  such  ad- 
ditional standards  as  shall  be  incorporated  in  the 
Constitution  and  Bylaws  of  the  Illinois  State  Medi- 
cal Society  and/or  the  county  medical  society. 
Section  2.  Offenses.  Any  member  of  a component 
society  shall  be  subject  to  censure,  suspension  or 
expulsion  by  such  component  society  when 

A.  He  has  been  adjudged  guilty  by  proper  civil 
authorities  of  a criminal  offense  involving 
moral  turpitude,  or 


B.  He  has  been  adjudged  guilty  by  his  compo- 
nent society  in  accordance  with  the  proced- 
ural requirement  of  these  bylaws; 

(1)  of  a gross  misconduct  as  a physician,  or 

(2)  of  a violation  of  the  Constitution  or  By- 
laws of  his  component  society,  or  of  the 
Illinois  State  Medical  Society,  or  of  the 
Principles  of  Medical  Ethics  promul- 
gated from  time  to  time  by  the  Ameri- 
can Medical  Association. 

Section  3.  Charges  Initially  Presented  to  the  Illi- 
nois State  Medical  Society.  Original  complaints  re- 
ceived by  the  Illinois  State  Medical  Society  shall 
be  referred  directly  to  the  secretary  of  the  com- 
ponent society  of  which  the  accused  is  a member 
or  to  the  district  Ethical  Relations  Committee. 
Section  4.  Principles  of  Justice.  The  following 
principles  of  justice  shall  guide  the  Ethical  Rela- 
tions Committee  in  all  disciplinary  procedures. 

A.  An  accused  is  presumed  to  be  innocent  until 
he  has  been  proven  guilty. 

B.  Formal  charges  before  the  Ethical  Relations 
Committee  of  the  component  society  or  dis- 
trict Ethical  Relations  Committee  must  be 
presented  under  oath  by  the  complaining 
party. 

C.  A trial  shall  be  held  by  the  committee  with- 
in 30  days  after  the  formal  charges  have  been 
filed,  unless  continued  by  the  chairman  of 
the  committee  upon  good  cause  shown. 

D.  The  individual  against  whom  formal  charges 
have  been  filed  shall  be  sent  a copy  of  said 
charges  by  certified  mail  at  least  10  days 
before  the  date  set  for  the  trial,  together 
with  a statement  of  the  rights  of  the  ac- 
cused as  follows: 

(1 ) to  be  represented  by  any  member  of  the 
society  as  counsel  and  that  he  may  have 
legal  counsel  present; 

(2)  to  cross-examine  witnesses; 

(3)  to  offer  in  evidence  any  pertinent  records 
or  documents; 

(4)  to  object  to  any  testimony  or  exhibits 
offered  in  evidence; 

(5)  to  address  the  trial  body  in  his  own 
behalf; 

(6)  to  be  tried  only  on  the  specific  charges 
filed; 

(7)  to  have  stricken  from  the  record  any  im- 
proper testimony  or  exhibits; 

(8)  to  appeal  to  the  Board  of  Trustees  of 
the  Illinois  State  Medical  Society. 

Section  5.  Records.  A comprehensive  stenographic 
record  of  the  proceedings,  together  with  all  ex- 
hibits, must  be  kept  for  reference,  and  shall  be 
available  until  final  adjudication  has  been  made. 

In  the  event  of  an  appeal  being  taken  from 
the  verdict  of  the  local  or  district  Ethical  Relations 
Committee,  the  stenographic  record  shall  be  for- 
warded by  certified  mail  to  the  Board  of  Trustees 


338 


Illinois  Medical  Journal 


of  the  ISMS  at  least  ten  days  prior  to  the  date 
the  appeal  is  to  be  heard. 

If  the  component  society  fails  to  provide  the 
record  on  appeal,  the  Ethical  Relations  Commit- 
tee of  Illinois  State  Medical  Society  shall  find  the 
accused  not  guilty. 

Section  6.  Verdict.  The  committee,  sitting  as  a trial 
body,  shall  find  the  accused  either  guilty  or  not 
guilty.  If  the  verdict  is  guilty,  the  trial  body  shall 
recommend  censure,  suspension  or  expulsion. 

The  findings  of  the  trial  body  must  be  presented 
to  the  component  county  society  for  approval  or 
rejection.  The  accused  must  be  notified  by  certi- 
fied mail  at  least  ten  days  before  the  date  set  for 
the  meeting  at  which  this  action  will  be  taken.  If 
the  findings  of  the  trial  body  are  against  the  ac- 
cused the  secretary  of  the  component  society  shall 
acquaint  the  accused,  by  certified  mail,  with  his 
right  of  appeal  within  thirty  days  to  the  Board  of 
Trustees  of  the  Illinois  State  Medical  Society. 

PART  2.  ILLINOIS  STATE  MEDICAL 
SOCIETY  PROCEDURES 

Section  1.  Illinois  State  Medical  Society  Ethical 
Relations  Committee.  The  Board  of  Trustees  shall 
appoint  from  its  members,  an  Ethical  Relations 
Committee  to  review  decisions  of  the  component 
society  involving  the  interpretation  of  the  Prin- 
ciples of  Medical  Ethics,  violations  of  the  Con- 
stitution and  Bylaws  of  the  Illinois  State  Medical 
Society  or  its  component  societies,  and  charges 
of  misconduct  of  members  of  the  Society. 

Section  2.  Appeals  from  Component  Society  Ver- 
dicts. Appeals  received  by  the  Illinois  State  Medi- 
cal Society  Board  of  Trustees  shall  be  referred  to 
the  Ethical  Relations  Committee  of  the  Board  for 
review.  (Appeals  must  be  accompanied  by  a com- 
prehensive stenographic  record  of  the  proceedings 
taken  before  the  component  county  society  to- 
gether with  all  exhibits  submitted  in  evidence.  If 
the  component  county  society  fails  to  provide  the 
record  on  appeal,  the  Ethical  Relations  Commit- 
tee of  Illinois  State  Medical  Society  shall  find 
the  accused  “not  guilty”).  The  committee  shall 
notify  the  accused  and  the  secretary  of  the  com- 
ponent society  by  certified  mail  at  least  thirty  days 
prior  to  the  date  set  for  the  hearing  of  the  appeal. 
The  chairman  of  the  committee  shall  preside  over 
the  hearing  in  accordance  with  the  rules  estab- 
lished by  the  Board  of  Trustees. 

Section  3.  Verdict.  The  Ethical  Relations  Commit- 
tee of  the  Board  of  Trustees  shall  hear  any  new 
and  pertinent  evidence  any  interested  party  de- 
sires to  present,  and  at  the  conclusion  of  the  trial, 
the  decision  of  the  component  society  shall  be 
affirmed,  overruled  or  sent  back  to  the  component 
society  for  reconsideration. 

Section  4.  Notification  and  right  of  appeal.  The 
secretary  of  the  Society  shall  notify  the  defend- 
ant and  the  secretary  of  the  component  society 


wherein  the  defendant  holds  membership,  of  the 
action  of  the  Board.  In  the  event  of  a decision 
against  the  accused  he  shall  have  the  right  to 
appeal  the  decision  to  the  Judicial  Council  of  the 
American  Medical  Association  and  the  secretary 
of  the  State  Society  shall  so  notify  the  accused 
of  this  right. 

CHAPTER  XII  PEER  REVIEW 
ILLINOIS  STATE  MEDICAL 
PART  1.  COMPONENT  SOCIETY  PROCEDURE 
Section  1.  Local  Peer  Review  Committee.  Each 
component  Society  shall  have,  either  by  appoint- 
ment or  election,  a Peer  Review  Committee  whose 
duties  it  shall  be  to  review  all  proper  complaints 
and  inquiries  brought  before  it  by  physicians,  pa- 
tients, institutions,  insurance  carriers,  or  govern- 
ment agencies. 

The  district  peer  review  committee  shall  func- 
tion and  operate  on  behalf  of  any  county  society 
which  does  not  establish  such  a committee. 
Section  2.  The  committee  shall  consist  of  a chair- 
man and  such  members  representing  both  general 
practice  and  various  specialties  as  each  individual 
county  society  shall  determine.  Such  committee 
should  have  access  to  counsel  from  each  of  the 
various  medical  specialties.  The  component  county 
society  may  establish  reasonable  rules  of  proced- 
ure but  shall  not  be  bound  by  the  technical  rules 
of  evidence  as  the  same  pertains  in  courts  of  law. 
All  proper  complaints  shall  be  reduced  to  writing 
and  shall  be  signed  by  the  individual  making  the 
complaint. 

Section  3.  Original  complaints  received  by  the 
Illinois  State  Medical  Society  shall  be  referred  to 
the  proper  county  society  or  to  the  district  com- 
mittee. 

Section  4.  The  Peer  Review  Committee  shall  in- 
clude the  functions  of  the  grievance  committee,  the 
prepayment  plans  and  organizations  committee, 
the  mediation  committee  and  any  other  commit- 
tee having  to  do  with  investigations  and  review 
but  shall  not  replace  or  supersede  the  ethical  re- 
lations committee. 

Section  5.  The  Peer  Review  Committee  shall  ini- 
tiate consideration  of  all  complaints  and  matters 
filed  with  it  within  60  days  from  the  date  of  filing 
and  shall  render  an  opinion  within  30  days  after 
the  conclusion  of  the  hearing.  In  the  event  the 
committee  does  not  follow  this  procedure  any 
party  may  appeal  for  relief  to  the  proper  district 
committee  whose  procedure  shall  be  the  same 
as  is  set  forth  herein  for  county  societies. 

Section  6.  The  Peer  Review  Committee  shall  have 
no  disciplinary  powers  but  instead,  shall  report 
its  findings  in  writing  to  all  parties  involved.  In 
the  event  the  investigation  and  study  of  the  com- 
mittee results  in  a determination  that  there  has 
been  a violation  of  law  or  unethical  conduct  on 
the  part  of  any  physician,  or  a violation  of  the 
Constitution  or  Bylaws  of  his  component  society; 


for  October,  1970 


339 


or  of  the  Illinois  State  Medical  Society,  or  of  the 
Principles  of  Medical  Ethics  promulgated  from 
time  to  time  by  the  American  Medical  Associa- 
tion, the  matter  shall  be  referred  in  writing  to 
the  component  society. 

Section  7.  In  its  study  and  deliberations  the  Peer 
Review  Committee  shall  evaluate  acts  by  the 
standards  established  by  the  House  of  Delegates 
of  the  American  Medical  Association  (specifically 
known  as  the  Principles  of  Medical  Ethics  of  the 
American  Medical  Association),  and  by  such  addi- 
tional standards  as  shall  be  incorporated  in  the 
Constitution  and  Bylaws  of  the  Illinois  State 
Medical  Society  and/or  the  county  medical  society. 
Section  8.  Any  party  to  the  proceedings  consider- 
ing himself  aggrieved  by  the  findings  and  recom- 
mendations of  the  committee  shall  have  the  right 
to  appeal  through  the  component  society  to  the 
Illinois  State  Medical  Society. 

Section  9.  In  the  event  of  an  appeal  to  the  Illinois 
State  Medical  Society,  the  county  society  shall 
send  to  the  Illinois  State  Medical  Society  a copy 
of  the  complaint,  the  exhibits  and  the  opinions 
of  the  county  or  district  committee.  Any  appeal 
hereunder  shall  be  filed  with  Illinois  State  Medi- 
cal Society  within  30  days  after  the  final  opinion 
of  the  county  or  district  committee  has  been 
rendered. 

PART  II.  ILLINOIS  STATE  MEDICAL 
SOCIETY  PROCEDURES 

Section  1.  All  appeals  received  by  the  Illinois  State 
Medical  Society  shall  be  referred  to  the  Council 
on  Economics  and  Peer  Review  of  the  Board  of 
Trustees,  which  shall  review  opinions  of  the  county 
or  district  peer  review  committee.  The  Council 
shall  have  the  power  to  counsel  with  and  obtain 
information  from  medical  specialists  when  appro- 
priate. 

Section  2.  The  Council  upon  receiving  notice  of 
an  appeal  shall  set  the  matter  for  hearing  within 
30  days  after  the  appeal  has  been  filed  and  at 
such  hearing  shall  review  the  record  sent  to  it 
from  the  county  society  or  district  society,  re- 
ceive additional  pertinent  evidence  any  interested 
party  desires  to  offer  and  render  its  conclusions 
and  findings  in  writing,  copies  of  which  shall  be 
mailed  to  all  interested  parties.  The  Peer  Review 
Committee  shall  have  no  disciplinary  powers  but 
instead,  shall  report  its  findings  to  all  parties  in- 
volved. The  conclusions  and  findings  shall  be  ad- 
visory only. 

Section  3.  The  Council  on  Economics  and  Peer 
Review  of  the  Illinois  State  Medical  Society  shall 
include  the  functions  of  the  grievance  commit- 
tee, the  prepayment  plans  and  organizations  com- 
mittee, the  mediation  committee  and  any  other 
committee  having  to  do  with  investigations  and 
review  but  shall  not  replace  or  supersede  the 
ethical  relations  committee. 


Section  4.  In  the  event  the  investigation  and  study 
of  the  Council  results  in  a determination  that 
there  has  been  a violation  of  law  or  unethical  con- 
duct on  the  part  of  any  physician,  or  a violation 
of  the  Constitution  or  Bylaws  of  his  component 
society,  or  of  the  Illinois  State  Medical  Society,  or 
of  the  Principles  of  Medical  Ethics  promulgated 
from  time  to  time  by  the  American  Medical  As- 
sociation, the  matter  shall  be  referred  in  writing 
back  to  the  component  society. 

CHAPTER  XIII.  MISCELLANEOUS 
Section  1.  The  fiscal  year  of  this  Society  shall  be 
from  January  1 to  December  31  inclusive. 
Section  2.  Robert’s  “Rules  of  Order,  Revised,” 
shall  be  the  guide  for  all  procedure  when  not  in 
conflict  with  the  Constitution  and  Bylaws. 

CHAPTER  XIV.  AMENDMENTS 
The  House  of  Delegates  may  amend  any  article  of 
these  Bylaws  by  a two-thirds  vote  of  the  delegates 
present  at  any  meeting,  provided  that  such  amend- 
ment shall  not  be  acted  upon  before  the  day  fol- 
lowing that  on  which  it  was  introduced. 

Order  of  Business  of  the 
House  of  Delegates 
FIRST  SESSION 

1.  Call  to  order. 

2.  Report  of  Committee  on  Credentials. 

3.  Roll  Call. 

4.  Reading  and  approval  of  minutes  of  last 
meeting. 

5.  Appointment  of  Reference  Committees. 

6.  Reports  of  Officers. 

7.  Reports  of  the  Trustees,  the  Editor,  etc. 

8.  Reports  of  Standing  Committees. 

9.  Reports  of  Board  Committees. 

10.  Reports  of  Special  Committees. 

11.  Reading  of  Resolutions. 

12.  Unfinished  Business. 

13.  New  Business. 

14.  Recess. 

LAST  SESSION 

1.  Call  to  order 

2.  Report  of  Committee  on  Credentials 

3.  Roll  Call 

4.  Reports  of  Reference  Committees 

5.  Fixing  of  per  capita  tax  for  ensuing  year 

6.  Selection  of  meeting  place  for  next  annual 
meeting.  (Subject  to  the  investigations  of  the 
Board.) 

7.  Unfinished  business 

8.  Election  of 

(a)  officers 

(b)  trustees 

(c)  delegates  to  the  AMA 

(d)  alternate  delegates  to  the  AMA 

9.  Induction  of  President  Elect  into  the  office 
of  President 

10.  New  business 

11.  Adjournment  (sine  die) 


340 


Illinois  Medical  Journal 


Index  to  Constitution  and  Bylaws 


Active  Members  327 

Amendments 

to  the  Bylaws  340 

to  the  Constitution  327 

American  Medical  Association 

election  of  Illinois  Delegates  330 

membership  330 

Annual  Convention 

date  of  the  329 

meeting  place  329 

scientific  meetings  329 

Annual  Dues  333 

Audit  and  Financial  Statement  332 

Benevolence,  Medical 

committee  336 

fund  332 

Board  of  Trustees 

bonding  332 

committees  332 

composition  331 

Duties  331 

election  by  House  of  Delegates  329 

election  of  Chairman  332 

executive  administrator  332 

meetings  332 

organization  332 

publications  332 

quorum  332 

vacancies  332 

Bonding  of  Officers  and  employees  332 

Bylaws  327 

Committees 

ad  hoc  336 

Advisory  to  Woman's  Auxiliary  337 

appointment  335 

Board  of  Trustees  336 

Committee  to  Study  336 

Constitution  and  Bylaws  336 

Executive  336 

Finance  336 

Publications  337 

Policy  336 

Reference  335 

Standing,  called  Councils  333 

Component  Societies  327 

Composition  of  the  Society  327 

Constitution  and  Bylaws 

Committee  on  336 

Councils 

organization  of  333 

reports  334 

terms  of  office  334 

duties  334 

County  Societies  337 

Discipline 

component  society  procedure  338 

state  medical  society  procedure  339 

District  committees  332 

District  divisions  330 

Dues  and  Expenses  333 

Duties 

of  officers  330 

of  trustees  331 


Election  of  Officers  330 

Emeritus  Members  328 

Ethical  Relations  336 

Executive  Administrator  332 

Executive  Committee  336 

Finance  Committee  336 

House  of  Delegates 

AMA  delegates  and  alternates  330 

appointment  of  ad  hoc  committees  330 

committees  330 

composition  329 

delegates  329 

district  divisions  330 

elections  330 

meetings  329 

order  of  business  340 

quorum  329 

registration  330 

special  meetings  329 

term  of  office  of  delegates  330 

Intern  Members  328 

Membership 

active  members  327 

emeritus  members  328 

intern  members  328 

qualifications  328 

residency  members  328 

special  members  327 

tenure  329 

withdrawal  of  privileges  329 

Officers 

election  330 

duties  330 

term  of  office  330 

Peer  Review 

Component  Society  Procedure  339 

State  Medical  Society  Procedure  340 

Policy  Committee  336 

President  330 

Provisional  membership  328 

Publications  .337 

Publications  Committee  337 

Purposes  of  the  Society  327 

Reference  Committees 

appointment  335 

duties  335 

organization  335 

Retired  Members  328 

Residency  Members  328 

Scientific  Meetings  329 

Seal  327 

Secretary-Treasurer  331 

Speaker  of  the  House  331 

Special  members 

distinguished  327 

election  328 

privileges  328 

Student  Committee  membership  329 

Successor  to  President-Elect  331 

Vacancies  on  Board  of  Trustees  332 

Vice-Presidents  331 

Vice  Speakers  331 

Woman's  Auxiliary  337 


for  October,  1970 


341 


Policy  Manual  of  the 
Illinois  State  Medical  Society 
May  1970 

“Policy  statements  shall  be  defined  as  guidelines  for  the  management  of  the  Illinois 
State  Medical  Society  affairs,  based  upon  prudence,  sound  judgment  and  experience.” 
“Rules  and  regulations  may  be  prepared  by  the  Board  of  Trustees  or  by  committees, 
for  use  in  the  implementation  of  policy.” 


This  manual  shall  be  a guide  for  officers,  trus- 
tees, committee  chairmen  and  headquarters  staff  to 
the  stand  taken  by  the  House  of  Delegates  of  the 
Illinois  State  Medical  Society  on  all  issues  involv- 
ing Society  policy. 

Its  statements  shall  combine  and  reconcile  the 
best  expressions  made  on  all  phases  of  policy  in- 
volving the  House  of  Delegates,  the  Board  of  Trus- 
tees and  the  various  committees. 

All  policy  statements  (except  those  involving 
the  funds  of  the  Society)  shall  have  the  approval 
of  the  House  of  Delegates,  since  the  Constitution 
and  Bylaws  provide  in  ARTICLE  V: 

“The  House  of  Delegates  shall  set  the  basic 
policy  and  philosophy  of  the  Society.” 

All  policy  statements  developed  during  the  in- 
terval between  meetings  of  the  House  shall  be  sub- 
mitted at  its  next  meeting  for  action.  The  House 
may: 

( 1 ) approve,  amend,  or  reject — 

(2)  refer  the  statement  to  the  Board  for  recon- 
sideration and  subsequent  report — 

(3)  remand  the  statement  to  the  committee 
from  which  it  came  for  further  study  and 
report. 

Policy  statements  for  the  consideration  of  the 
House  may  appear  as  a portion  of  the  annual  re- 
port of  the  Policy  Committee,  or  they  may  be 
contained  in  other  reports  to  the  House.  The  final 
statements  for  publication  in  this  Policy  Manual 
are  to  be  prepared  by  the  Policy  Committee.  Any 
member  of  the  Illinois  State  Medical  Society  may 
submit  a policy  statement  for  consideration. 

Temporary  policy  between  meetings  of  the 
House  is  determined  by  the  Board.  Committees 
may  request  Board  consideration  at  any  time. 

The  Illinois  State  Medical  Society  shall  support 
policy  statements  approved  by  the  House  of  Dele- 
gates of  the  American  Medical  Association. 

National  policy  is  the  prerogative  of  the  na- 
tional association.  Until  specific  contrary  action 
emanates  from  the  AMA  House  of  Delegates,  the 
Board  of  Trustees  and  the  officers  of  the  ISMS 
shall  consider  all  such  policy  as  binding. 

Policy  action  at  the  state  level  does  not  rescind 
official  AMA  rulings  in  Illinois,  and  the  Society 
must  recognize  such  policy  until  it  has  been 
changed  at  the  national  level. 

The  same  “chain  of  command”  should  exist  be- 
tween the  county  medical  society  and  the  ISMS 
House  of  Delegates.  Policy  established  at  the  State 


Society  level  must  prevail  until  majority  action  by 
the  House  of  Delegates  has  rescinded  or  reversed 
the  statements.  This  represents  “majority  rule”  and 
must  be  followed  closely  to  preserve  the  demo- 
cratic processes. 

Alcoholism 

“Since  alcoholism  has  been  widely  regarded  as 
a disease  for  some  time  and  because  it  is  impos- 
sible to  differentiate  immediately  between  a 
chronic  alcoholic  and  any  other  intoxicated  per- 
son, the  individual  who  is  acutely  ill  from  alcohol 
ingestion  should  be  considered  a health  problem 
and  therefore  be  adjudicated  within  the  purview 
of  the  medical  and  other  health  professions.” 

Assessments 

Compulsory  assessments  of  members  of  hospital 
staffs  for  any  purpose  are  unethical  and  improper. 

Athletic  Programs 

Children  of  school  age,  through  the  9th  grade, 
should  not  participate  in  body  contact  sports. 

Elementary  school  children  develop  better  physi- 
cally if  activities  are  informal  and  not  highly  com- 
petitive. 

Medical  supervision  of  all  athletic  programs  is 
essential. 

Audits  & Surveys 

(Hospital,  nursing  homes,  etc.) 

Audits  and  surveys  which  impinge  on  personal 
privacy,  patient  care  and  local  hospital  trustee 
and  medical  decisions  as  to  management  should 
not  be  condoned. 

Autonomy  of  County  Medical  Societies 

No  ruling  of  any  county  medical  society  shall 
conflict  with  the  Principles  of  Medical  Ethics  of 
the  American  Medical  Association,  or  with  the 
Constitution  and  Bylaws  of  the  Illinois  State  Medi- 
cal Society. 

In  all  other  areas,  the  county  society  shall  be 
autonomous. 

Birth  Certificates 

Birth  certificates  should  contain  only  such  items 
as  are  pertinent  to  their  function.  Information  re- 
corded on  birth  certificates  should  not  be  provided 
to  organizations  or  individuals  for  other  than  ap- 
proved purposes. 

Budgets— (see  "Financial  Policies") 


342 


Illinois  Medical  Journal 


Committee  Appointments 

The  chairman  of  the  Board  of  Trustees  and  the 
officers  of  ISMS  shall  give  the  trustees  an  oppor- 
tunity to  recommend  physicians  from  their  dis- 
tricts for  appointment  to  various  committees. 
Trustees  shall  receive  the  proposed  list  of  com- 
mittee appointments  for  their  consideration  and 
review  prior  to  the  meeting  of  the  Board  at  which 
the  final  committee  personnel  is  to  be  approved. 

Elective  committees  should  serve  for  uniform 
terms  of  office — preferably  three  years.  These 
terms  of  office  should  be  held  on  a staggered  basis 
to  provide  continuity  in  the  committee  structure. 
Individual  tenure  on  any  committee  should  be 
limited  to  a maximum  of  nine  years  of  continuous 
membership — whether  elected  or  appointed. 

Physicians  appointed  to  an  Illinois  State  Medi- 
cal Society  committee  must  be  members  in  good 
standing  of  this  Society. 

Communicable  Diseases 

Physicians,  especially  those  engaged  in  public 
health  work,  should  enlighten  the  public  concern- 
ing all  regulations  and  measures  for  the  prevention 
and  control  of  communicable  diseases.  When  an 
epidemic  prevails,  a physician  shall  continue  his 
labors  without  regard  to  his  own  health. 

Community  Health  Week 

The  medical  profession  shall  provide  the  scien- 
tific leadership  to  focus  attention  on  the  health 
needs  of  the  community  and  to  encourage  and 
assist  in  developing  Community  Health  Week 
activities. 

Conflict  of  Interest 

When  a case  of  conflict  of  interest  arises  and  is 
self-evident,  by  the  attitude  shown  by  the  indi- 
vidual concerned,  it  should  be  referred  to  the 
Executive  Committee  of  the  Board  of  Trustees 
of  the  ISMS  for  consideration. 

Constitution  and  Bylaws 

Final  copy  of  any  changes  made  by  the  House 
of  Delegates  in  the  Constitution  and/or  the  Bylaws 
shall  be  prepared  for  publication  by  the  Commit- 
tee on  Constitution  and  Bylaws,  in  consultation 
with  legal  counsel,  making  sure  that  the  published 
changes  reflect  the  thinking  expressed  by  the  action 
of  the  House. 

Continuing  Education 

Continuing  education  shall  be  one  of  the  basic 
purposes  of  the  Illinois  State  Medical  Society  for 
scientific  advancement,  humanization  of  medicine, 
improvement  of  medical  public  relations,  and  de- 
velopment of  cooperation  and  rapport  with  the 
public. 

Co-operation  with  the  American 
Medical  Association 

Actions  of  the  AMA  House  of  Delegates  are 
binding  upon  its  membership  at  all  levels,  county, 
state  and  national. 

(Since  all  members  of  the  Illinois  State  Medical 
Society  are  also  members  of  the  American  Medical 


Association,  this  is  universally  true  in  Illinois.  The 
right  to  disagree,  the  right  to  protest,  the  right  to 
become  “the  loyal  opposition”  is  not  questioned. 
However,  until  such  time  as  the  AMA  House  has 
reversed  its  decision,  it  is  mandatory  that  the  mem- 
bership abide  by  the  will  of  the  majority.) 

Cultists,  Association  with 
(Association  with  Osteopaths— see  "0") 

The  Judicial  Council  of  the  American  Medical 
Association  has  ruled  that  it  is  unethical  to  asso- 
ciate VOLUNTARILY  with  an  individual  who 
practices  as  a member  of  a “cult.” 

Disaster  Control 

Any  disaster  creates  an  obvious  need  for  trained 
personnel  to  aid  the  sick  and  injured.  Local  medi- 
cal societies  should  cooperate  to  provide  medical 
self-help  programs.  County  societies  should  pro- 
vide training  for  their  membership  in  the  treatment 
of  mass  casualties,  radiological  casualties  and  in 
the  organization,  operation  and  maintenance  of 
emergency  hospitals. 

Discrimination— (see  "Freedom  of 
Choice") 

Dues,  Recommendation  of  the  Board 
to  the  House 

The  chairman  of  the  Board  of  Trustees  shall 
place  the  question  of  dues  for  the  coming  year  on 
the  agenda  for  consideration  at  the  spring  meeting 
of  the  Board. 

Immediately  following  this  meeting,  written  no- 
tice of  the  recommendation  regarding  dues  for  the 
next  fiscal  year,  shall  be  mailed  to  all  delegates  and 
alternate  delegates  from  the  component  societies, 
and  also  to  all  presidents  and  secretaries  of  county 
medical  societies.  This  recommendation  shall  also 
be  published  in  the  Illinois  Medical  Journal  as  a 
part  of  the  annual  report  of  the  Chairman  of  the 
Board. 

Education,  Primary  and  Secondary 

Primary  and  secondary  education  is  a com- 
munity problem.  In  order  to  retain  jurisdiction  of 
these  grade  schools,  finances  should  be  raised  by 
taxation  at  the  local  level. 

Ethics 

Cases  involving  ethics  shall  reach  the  state  so- 
ciety level  only  by  means  of  an  appeal.  As  outlined 
in  the  Bylaws,  the  state  society  committee  shall 
serve  only  as  an  appellate  body  to  review  such 
cases. 

Examinations 

All  physical  examinations  should  be  performed 
in  the  physician’s  office.  No  examinations  should  be 
conducted  on  a group  basis  unless  authorization 
has  been  given  by  the  local  county  medical  society 
in  a single  instance  or  for  a specific  purpose. 

This  general  statement  does  not  apply  to  the 
industrial  or  occupational  health  physician  in  his 
in-patient  activities. 

Facility  Medical  Boards  (Physicians) 

In  all  legislation  which  establishes  boards  for 


/or  October,  1970 


343 


the  administration  of  medical  facilities  operated 
by  governmental  units,  at  least  one-third  of  the 
board  should  be  physicians  licensed  to  practice 
medicine  in  all  its  branches. 

Federal  Funds 

When  a federal  government  assistance  program 
is  essential  it  should  be  conducted  under  the  ad- 
ministration and  control  of  local  government.  The 
Society  does  not  favor  any  federal  assistance  pro- 
gram which  removes  administrative  control  from 
the  state  or  local  level. 

Fee  Schedules 

No  member  or  committee  shall  be  permitted  to 
approve  a fee  schedule  for  the  Illinois  State  Medi- 
cal Society  until  it  has  been  submitted  to  and  ap- 
proved by  the  House  of  Delegates  or  the  Board  of 
Trustees. 

Individuals  covered  by  various  fee  schedules 
shall  receive  the  best  type  medical  care  in  all 
cases,  and  the  physicians  involved  shall  be  remun- 
erated according  to  the  accepted  fee  schedule.  Fees 
should  be  commensurate  with  services  rendered. 

Financial  Policies 

(also  see  "Assessments,"  etc.) 

(1)  The  Finance  Committee  is  to  make  budg- 
etary recommendations  to  the  Board  of  Trustees; 
however,  such  recommendations  must  be  approved 
by  the  Board. 

(2)  The  expenses  of  any  duly  elected  delegate 
or  alternate  delegate  attending  the  meetings  of  the 
House  of  Delegates  of  the  American  Medical  Asso- 
ciation shall  not  be  assumed  by  the  ISMS  until  he 
enters  his  official  term  of  office  set  by  the  Consti- 
tution and  Bylaws  of  the  AMA. 

(3)  The  expenses  of  any  official  representative 
of  the  ISMS  attending  any  authorized  meeting 
shall  be  determined  by  the  Finance  Committee  and 
approved  by  the  Board  of  Trustees. 

(4)  Any  new  project  authorized  by  House 
action  requiring  the  expenditure  of  funds  must  be 
accompanied  by  an  estimate  of  the  cost  and  sug- 
gested methods  of  providing  the  necessary  funds. 

(5)  Budgets  submitted  to  the  House  by  the 
Board  should  provide  for  the  ensuing  fiscal  year. 

(6)  In  addition  to  fixed  reserves,  the  develop- 
ment of  a contingency  reserve  is  desirable. 

(7)  All  financial  records  shall  be  available  at 
headquarters  office,  and  may  be  examined  by  any 
member  of  the  Society.  A semi-annual  summary 
of  the  financial  statements  of  the  Society  shall 
be  mailed  to  any  county  society  secretary  or  dele- 
gate if  requested.  A projected  budget  for  the  next 
fiscal  year  shall  be  mailed  to  the  members  of  the 
House  of  Delegates  at  least  30  days  prior  to  the 
annual  convention.  These  reports  shall  be  in  the 
format  customarily  used  in  ordinary  corporate 
practice. 

Freedom  of  Choice 

The  mutual  right  of  physicians  and  patients  to 
exercise  freedom  of  choice  in  medical  matters  shall 
be  maintained.  This  includes  the  right  of  the  pa- 


tient to  choose  the  physician  by  whom  he  will  be 
served,  and  the  right  of  the  physician  (except  in 
emergencies)  to  a corresponding  freedom  of 
choice.  All  members  of  the  Illinois  State  Medical 
Society  enjoy  the  same  rights  and  privileges  and 
are  bound  by  the  same  obligations  and  standards 
of  professional  conduct. 

Health  Care— Ancillary  Services 

All  segments  of  our  population  are  entitled  to 
and  shall  receive  the  best  health  care  available. 
The  physicians  in  Illinois  are  encouraged  to  co- 
operate in  the  implementation  of  any  national 
program  meeting  with  the  general  policy  state- 
ments of  the  Society.  (This  shall  be  interpreted 
to  include  health  aspects  in  nursing  home  care, 
use  of  recreational  facilities,  environmental  health, 
public  health,  employment  problems,  etc.,  and 
any  other  area  which  involves  the  health  of  the 
residents  of  this  State.) 

Health  Care  Costs 

The  public  should  be  educated  concerning  the 
difference  between  “health  care  costs”  and  “medi- 
cal care  costs.”  Members  of  the  profession  should 
cooperate  with  the  various  ancillary  groups  and 
should  be  able  to  explain  the  cost  factors  involved 
in  total  care. 

Health  Careers 

All  capable  and  worthy  individuals  interested  in 
medicine  as  a career  shall  be  encouraged  and  as- 
sisted by  the  Illinois  State  Medical  Society.  Those 
interested  in  paramedical  fields  shall  be  provided 
with  all  pertinent  information. 

Hospitals 

Physicians  should  sponsor  and  assist  in  the  de- 
velopment of  all  medical  staff  committees  within 
the  hospital. 

The  local  medical  profession  should  cooperate 
to  achieve  the  accreditation  of  all  eligible  hospitals, 
and  should  encourage  the  stabilization  or  reduc- 
tion of  hospital  costs  in  all  areas  where  they  have 
authority. 

Hospital  Assessments— See  Assessments 
Hospital  Committees  (Dealing  with  phy- 
sician-patient relationship) 

All  committees  dealing  with  the  review  of  phy- 
sician-patient relationship  in  hospitals  and  nurs- 
ing homes  are  urged  not  to  release  findings  to 
any  third  parties  except  by  subpoena  or  court 
order.  Any  reports  issued  by  the  committees  in- 
volved should  be  submitted  to  the  chief  of  staff 
for  his  disposition. 

Hospital  Records  and  Their  Availability* 

Hospital  records  are  privileged  information  and 
the  property  of  the  patient,  kept  in  trust  by  the 
hospital.  They  are  not  to  be  released  except  on  a 
court  order. 

Upon  receipt  of  a request  signed  by  the  patient, 
an  abstract  or  a summary  shall  be  provided  when 
*Under  consideration  for  report  by  the  Commit- 
tee to  Board  and  1971  House. 


344 


Illinois  Medical  Journal 


needed,  to  insurance  companies,  governmental 
agencies,  consulting  physicians,  etc. 

Hospital  StafF  Privileges 

The  medical  staff  of  a hospital  does  not  have 
the  privilege  or  the  right  to  make  compulsory  as- 
sessments of  members  of  the  medical  staff  for 
building  funds,  or  to  demand  an  audit  of  staff 
members’  personal  financial  records  as  a requisite 
for  staff  appointments. 

House  of  Delegates,  Special  Meetings  of 

When  a special  meeting  of  the  House  of  Dele- 
gates is  scheduled  which  may  involve  an  increase 
in  dues  or  a special  assessment,  the  call  for  that 
meeting  shall  contain  specific  notification  of  that 
possibility. 

Immunization  Program 

Illinois  residents  should  be  provided  all  types  of 
immunization.  Physicians  are  requested  to  provide 
this  protection  especially  to  all  children,  or  to  en- 
courage the  local  public  health  agency  to  perform 
this  function. 

Every  school  should  have  a school  health  com- 
mittee with  at  least  one  physician  as  a member. 
County  advisory  school  health  councils  should  as- 
sist in  coordination. 

Impartial  Medical  Testimony 

The  ends  of  justice  are  served  when  impartial 
medical  witnesses  are  available  to  give  testimony. 
The  ISMS  supports  this  concept  and  offers  its 
assistance  in  the  provision  of  impartial  medical 
testimony. 

Indigent,  The  Care  of  the 

Personal  medical  care  is  primarily  the  responsi- 
bility of  the  individual.  When  he  is  unable  to  pro- 
vide this  care  for  himself,  the  responsibility  should 
properly  pass  to  his  family,  the  community,  the 
county,  the  state,  and  only  when  all  these  fail,  to 
the  federal  government,  and  only  in  conjunction 
with  the  other  levels  of  government  in  the  order 
above. 

The  determination  of  medical  needs  should  be 
made  by  a physician.  The  determination  of  eligi- 
bility should  be  made  at  the  local  level  with  local 
administration  and  control.  The  principle  of  free- 
dom of  choice  should  be  preserved. 

Individual  Rights 

Since  this  Society  believes  that  a strong  America 
is  a free  America,  the  rights  of  an  individual,  or  a 
group  of  individuals,  to  openly  express  them- 
selves cannot  be  condemned  even  if  one  is  in 
complete  disagreement,  if  the  laws  of  the  land  are 
not  violated.  To  support  such  condemnation  would 
be  inconsistent  with  this  Society’s  basic  philoso- 
phy. 

Insurance  Plans 

Physicians  are  urged  to  cooperate  with  voluntary 
health  insurance  plans  approved  by  the  Illinois 
State  Medical  Society. 


Fixed  fee  schedules  should  not  be  accepted.  All 
fees  should  be  based  upon  the  usual  and  cus- 
tomary fee  concept. 

Insurance  programs  for  the  membership  of  the 
Illinois  State  Medical  Society  should  be  studied 
and  implemented  by  the  proper  committee.  Major 
medical  and  comprehensive  hospital  group  cov- 
erage should  be  part  of  this  insurance  package. 

Journal  Publication 

The  Publications  (Journal)  Committee,  with  the 
approval  of  the  Board  of  Trustees,  has  authority 
over  the  publication  policy  and  the  screening  of  all 
advertisers  and  advertising  copy  appearing  in  the 
Illinois  Medical  Journal. 

Laboratories 

All  laboratories  providing  medical  data  should 
be  under  the  direct  supervision  of  a physician. 

Lay  Employees  and  Their  Prerogatives 

Policy  is  established  by  the  House  of  Delegates. 

Staff  shall  cooperate  with  officers  and  committee 
chairmen  in  setting  up  activities  and  in  carrying 
out  alt  necessary  routine. 

Staff  also  shall  keep  new  officers  and  committee 
chairmen  aware  of  policy  statements,  and  assist 
them  in  the  preparation  of  reports  to  the  House 
of  Delegates  to: 

change  existing  policy 
establish  new  policy 
request  House  approval  of  committee 
projects  and/or 
procedure  involving  policy 

Committees  shall  be  informed  of  their  right  to 
set  up  operating  rules  and  regulations. 

Legal  Counsel 

The  legal  counsel  of  the  Illinois  State  Medical 
Society  shall  concern  himself  with  official  inquiries 
from  officers,  trustees,  committee  chairmen  and 
county  medical  societies.  Such  inquiries  shall  be 
channeled  through  the  Executive  Administrator. 

Legislation 

All  matters  pertaining  to  state  or  federal  leg- 
islation shall  be  referred  to  the  Legislative  Com- 
mittee for  consideration  and  recommendation  prior 
to  Board  of  Trustees  and/or  House  of  Delegates 
action. 

Matters  pertaining  to  federal  legislation  shall  be 
checked  against  recommendations  or  policies  of 
the  American  Medical  Association  by  the  Council 
on  Legislation  of  the  Illinois  State  Medical 
Society  prior  to  making  a recommendation  either 
to  the  Board  of  Trustees  or  to  the  House  of  Dele- 
gates. 

Before  any  legislation  is  developed  for  presen- 
tation to  the  Illinois  General  Assembly,  the  pro- 
posed law  shall  be  considered  by  the  Council  on 
Legislation,  which  shall  work  in  close  cooperation 
with  any  other  Society  committee  involved.  The 
instigating  committee  should  determine  the  con- 
tent of  the  law  and  the  Legislative  Council 


for  October,  1970 


345 


primarily  should  consider  relationship  of  the  pro- 
posed legislation  to  the  total  legislative  program. 

Mailing  List 

The  use  of  the  mailing  list  of  ISMS  members 
must  be  approved  by  special  action  of  the  Board 
of  Trustees. 

Medical  Care,  Provision  of 

Medical  care  shall  be  provided  regardless  of  the 
ability  of  the  patient  to  pay.  Physicians  shall  not 
refuse  to  render  needed  emergency  care  to  any 
patient. 

Medical  Representation  in  Government 
Planning 

In  health  programs  financed  by  government 
funding  in  an  Illinois  community,  there  shall  be 
representation  at  the  highest  policy  level  by  an 
official  representative  of  the  State  Society  and  the 
appropriate  county  medical  society  Involved.  Re- 
muneration for  services  in  above  programs  shall 
follow  the  policies  of  the  Illinois  State  Medical 
Society. 

Membership  in  Paramedical  and 
Service  Organizations 

Membership  in  Chambers  of  Commerce  (city, 
state  and  national)  is  to  be  encouraged.  This  policy 
extends  to  the  individual  physician  as  well  as  to 
the  component  societies. 

Membership  in  the  Illinois  Association  of  the 
Professions  is  encouraged.  Medicine  should  be 
well  represented  among  these  allied  professional 
groups  and  the  growth  and  development  of  the  As- 
sociation is  of  concern  to  ISMS  economically,  po- 
litically and  scientifically. 

The  Society  recommends  that  physicians  affiliate 
with  service  clubs,  local  political  action  groups  and 
participate  to  the  fullest  extent  possible  in  affairs 
affecting  the  health  and  welfare  of  the  residents  of 
Illinois. 

Membership  of  Osteopathic  Physicians 
in  ISMS 

Osteopathic  physicians  who  meet  all  qualifica- 
tions for  membership,  base  their  practice  on  the 
same  scientific  principles  as  those  adhered  to  by 
members  of  the  AMA,  and  are  licensed  to  prac- 
tice medicine  in  all  its  branches  in  Illinois,  may 
be  accepted  as  active  members  by  the  county 
medical  societies  throughout  the  state,  and  be  ac- 
corded all  privileges  of  full  membership  at  the 
county  and  state  levels  and  be  so  reported  to  the 
American  Medical  Association  for  acceptance  at 
that  level. 

Mental  Health 

Mental  health  planning  should  be  implemented 
at  the  community  level.  County  medical  societies 
should  be  kept  aware  of  their  responsibilities  to 
assist  in  developing  improved  mental  health  fa- 
cilities. 

A physician  licensed  to  practice  medicine  in  all 
its  branches  should  be  required  to  certify  the  dis- 
charge of  any  patient  from  a psychiatric  institu- 
tion. 


Shortage  of  Nurses 

A severe  shortage  of  graduate  nurses  continues 
to  imperil  the  provision  of  quality  patient  care. 
The  ISMS  supports  all  forms  of  qualified  nursing 
education  and  urges  that  all  such  schools  be  en- 
couraged to  remain  in  operation. 

Occupational  Health 

Occupational  health  is  an  essential  ingredient  of 
employee  welfare.  The  adoption  and  development 
of  health  programs  in  industry  should  be  en- 
couraged. 

Occupational  health  will  be  advanced  through 
the  utilization  of  all  physicians  involved  in  indus- 
trial work. 

Osteopaths,  Association  with 

Voluntary  professional  associations  with  a Doc- 
tor of  Osteopathy  are  not  deemed  unethical  if 
the  Doctor  of  Osteopathy  bases  his  practice  on 
the  same  scientific  principles  as  those  adhered  to 
by  members  of  the  American  Medical  Association 
and  if  he  is  licensed  to  practice  medicine  and 
surgery  in  all  of  its  branches  in  Illinois. 

Placement  Service 

Before  the  Physicians’  Placement  Service  rec- 
ommends that  a town  in  Illinois  be  listed  as  need- 
ing a physician,  it  shall  be  established  that  the  need 
actually  exists;  that  the  community  can  support  a 
physician;  that  certain  physical  assets  (office — 
home — schools,  etc.)  are  available  for  the  physi- 
cian and  his  family. 

The  qualifications  of  the  physician  also  shall  be 
ascertained  prior  to  furnishing  him  with  the  list  of 
available  areas  in  Illinois  needing  a physician. 

Policy  Stat’ements 

Policy  statements  shall  be  defined  as  guide 
lines  for  the  management  of  the  Illinois  State 
Medical  Society  affairs,  based  upon  prudence, 
sound  judgment  and  experience. 

Rules  and  regulations  may  be  prepared  by  the 
Board  of  Trustees  or  by  committees,  for  use  in 
the  implementation  of  policy. 

Polls,  Opinion 

The  vote  of  the  House  of  Delegates  shall  ex- 
press the  opinion  of  the  majority  of  the  Illinois 
State  Medical  Society  membership.  Since  delegates 
are  the  duly  elected  representatives  of  their  county 
medical  societies  and  their  voting  reflects  the 
thinking  of  their  constituents,  a majority  opinion 
HAS  BEEN  expressed,  and  a membership  poll 
becomes  unnecessary  except  under  very  exceptional 
conditions. 

Prepayment  Plans  and  Organizations 

It  is  not  within  the  province  of  ISMS  to  act  in 
other  than  an  advisory  capacity  when  working  with 
a “third  party  plan,”  and  its  best  efforts  should  be 
directed  toward  supplying  guidance,  education  and 
communications  between  the  membership  and  the 
prepayment  plans  and  organizations  involved. 

The  principle  of  free  enterprise  as  exemplified 


346 


Illinois  Medical  Journal 


by  private  insurance  companies  and  the  “Blue” 
plans  is  to  be  endorsed. 

Press 

All  county  medical  societies  should  cooperate 
with  the  local  press.  The  public  should  be  pro- 
vided with  prompt  and  accurate  information  in  all 
health  fields;  the  source  of  this  information  should 
be  the  medical  profession. 

County  medical  societies  should  provide  infor- 
mation at  the  local  level;  the  State  Society  is 
responsible  for  press  releases  involving  State  So- 
ciety officers  or  any  official  statements  of  the 
Society  appearing  in  the  press. 

A code  of  ethics  applicable  to  medicine  and  the 
fourth  estate  should  be  developed.  (That  used  in 
the  Decatur  area  has  been  given  national  recogni- 
tion by  the  AM  A.) 

Publication  of  Research  Data 

In  releasing  research  material  for  publication 
in  the  Illinois  Medical  Journal,  or  any  other 
media,  extreme  care  should  be  exercised.  The 
welfare  and  privacy  of  the  patient,  the  professional 
reputation  of  the  physician  should  be  of  primary 
concern. 

If  any  question  arises,  consultation  with  the 
Board  of  Trustees  is  suggested.  All  such  inquiries 
should  be  addressed  to  its  chairman. 

Public  Affairs 

No  officer  or  member  of  the  Board  of  Trustees 
should  be  permitted  (during  his  term  of  office)  to 
allow  his  name  as  an  officer  or  a member  of  the 
Board  to  be  used  in  lists  endorsing  candidates  for 
public  office.  Naturally  his  right  to  this  privilege 
as  a private  individual  is  not  affected. 

Public  Aid 

The  “chain  of  command  and  procedure”  in  han- 
dling problems  arising  in  the  field  of  public  aid 
shall  be  from  the  county  to  the  state  society  ad- 
visory committee;  then  the  state  advisory  com- 
mittee shall  assume  the  responsibility  of  making 
the  medical  program  work  and  cooperating  with 
the  Illinois  Department  of  Public  Aid  to  maintain 
the  best  type  medical  care  for  the  recipients  of 
state  aid. 

The  fees  paid  by  the  state/federal  programs  to 
physicians  shall  be  based  upon  the  usual  and  cus- 
tomary fee  concept. 

An  extensive  program  of  education  should  be 
conducted  for  the  recipients  of  public  aid.  This 
should  include  the  intelligent  handling  of  all  mon- 
ies provided. 

Rehabilitation  of  all  recipients  should  be  of  para- 
mount concern. 

Public  Health  Departments 

“Public  Health  is  the  art  and  science  of  main- 
taining, protecting  and  improving  the  health  of 
the  people  through  organized  community  efforts, 
including  contributions  by  voluntary  health  asso- 
ciations, medical  societies  and  other  health- 
oriented  groups. 

“Full-time  modern  local  Health  Departments 


adequately  financed  and  staffed  at  the  county  or 
multiple  county  level  are  highly  desirable  and 
if  available,  would  be  capable  of  providing  these 
services  to  the  people  throughout  the  state.  It 
is  of  paramount  importance  that  such  depart- 
ments should  be  established  where  none  now 
exist  and  that  county  medical  societies,  as  well 
as  physicians,  should  give  their  wholehearted  sup- 
port.” 

Public  Safety 

Motor  vehicle  operators  should  be  licensed  on 
the  basis  of  the  applicant’s  physical  and  mental 
capacity  to  operate  such  a vehicle  safely. 

Rebates 

1)  “In  conformity  with  the  AMA  Principles 
of  Ethics,  rebates  of  any  nature  to  any  member, 
county  or  regional  medical  society,  are  unethical.” 
This  statement  on  rebates  was  developed  as  a 
result  of  a letter  regarding  collection  services. 
It  read  in  part: 

“It  is  our  policy  to  remit  to  a participating  as- 
sociation the  sum  of  10  per  cent  of  the  gross 
book  sales  to  its  members  in  addition  to  10 
per  cent  of  the  gross  commissions  received  from 
collections.  A report  and  accompanying  pay- 
ment is  submitted  monthly  from  our  office.” 

Reference  Committee  Appointments 

Whenever  possible  at  least  two  members  shall 
be  retained  on  all  reference  committees  for  the 
following  year  in  order  to  effect  continuity  of  ex- 
perience. 

Reference  Service 

Physician  reference  service  shall  be  the  respon- 
sibility of  the  county  medical  society.  When  any 
such  request  is  received  at  the  state  society  office 
or  by  any  officer  of  the  ISMS,  it  shall  immediately 
be  referred  to  the  secretary  of  the  county  medical 
society  involved. 

Rehabilitation 

All  physical  rehabilitation  activities  should  be 
prescribed  by  a physician  and  the  treatment  car- 
ried out  under  the  supervision  of  a physician. 

Medical  societies  should  render  assistance  to 
public  and  private  agencies  regarding  rehabilita- 
tion facilities  to  be  used  and  in  the  selection  of 
patients  for  these  services. 

Insurance  carriers  should  be  encouraged  to  in- 
clude rehabilitation  services  in  their  contracts. 

Relative  Value 

The  Relative  'Value  Study  is  not  a fee  schedule 
and  is  to  be  used  for  information  only. 

No  co-efficient  shall  be  established  at  the  state 
level.  The  data  contained  in  the  study  may  be 
used  by  the  ISMS,  its  committees  or  by  any 
county  medical  society. 

The  study  should  be  revised  at  appropriate  in- 
tervals upon  the  recommendation  of  the  com- 
mittee with  the  approval  of  the  Board  of  Trus- 
tees. 

Upon  request,  copies  may  be  furnished  third 
party  purveyors  of  health  care  services. 


for  October,  1970 


U1 


Specialty  Society  Representation 
on  ISMS  Councils 

For  the  improvement  of  communication  and 
the  discussion  of  problems  of  mutual  interest  and 
concern,  closer  liaison  between  specialty  societies 
of  medicine  and  the  councils  of  the  Board  of 
Trustees  is  desirable.  Representatives  to  serve  in 
this  capacity  may  be  nominated  by  the  specialty, 
society,  approved  by  the  Board  of  Trustees  of 
ISMS,  and  designated  as  consultants  to  the  coun- 
cil without  vote,  in  compliance  with  the  Bylaws. 

Stationery,  Use  of  Official 

No  officer,  trustee,  committee  chairman  or  staff 
director  is  to  use  the  official  stationery  of  the  Il- 
linois State  Medical  Society  tor  personal  state- 
ments of  any  nature.  This  shall  pertain  especially 
to  the  endorsement  of  any  candidate  for  public  of- 
fice. 

Surveys 

The  Illinois  State  Medical  Society  endorses  the 


principle  of  mass  surveys  and  encourages  the  use 
of  this  method  whenever  it  meets  with  the  ap- 
proval of  the  local  county  medical  society. 

Any  new  state  program  involving  more  than  one 
county  society  should  be  submitted  to  the  Board  of 
Trustees  for  initial  approval. 

Veterans  Administration 

It  is  our  belief  that  a Veterans  Administration 
hospital  should  admit  only  those  patients  with 
service-connected  disabilities,  except  in  those  in- 
stances where  the  veteran  is  financially  unable  to 
pay  for  his  medical  care  and  hospital  services,  as 
shown  by  a means  test. 

Woman's  Auxiliary 

Projects  in  which  the  Auxiliary  participates  shall 
be  approved  by  the  local  county  medical  society. 

Requests  for  cooperation  between  the  Auxiliary 
and  the  Illinois  State  Medical  Society  should  be 
channeled  through  the  Advisory  Committee  pro- 
vided by  the  Board  of  Trustees. 


INDEX  TO  POLICY  MANUAL 


Alcoholism  342 

Assessments  and/or  Dues  342 

Assessments,  Compulsory  342 

Athletic  Programs  342 

Audits  and  Surveys  342 

Autonomy  of  County  Society  342 

Birth  Certificates  342 

Budgets  (see  “Financial  Policies”)  342 

Committee  Appointments  343 

Communicable  Diseases  343 

Community  Health  Week  343 

Conflict  of  Interest  343 

Constitution  and  Bylaws  343 

Continuing  Education  343 

Co-operation  with  the  AMA  343 

Cultists,  Association  with  343 

Disaster  Control  343 

Discrimination  (See  “Freedom  of  Choice”) 

Dues,  Recommendation  to  the  House  343 

Education,  Primary  and  Secondary  343 

Ethics  343 

Examinations 343 

Facility  Medical  Boards  (Physicians)  343 

Federal  Funds  344 

Fee  Schedules  344 

Financial  Policies  344 

Freedom  of  Choice  344 

Government  Planning 

(See  “Medical  Representation”)  346 

Health  Care — Ancillary  Services  344 

Health  Care  Costs  344 

Health  Careers  344 

Hospitals  344 

Hospital  Assessments  (See  “Assessments”)  ....344 
Hospital  Audits  (See  “Audits  & Surveys”)  ....342 

Hospital  Committees  344 

Hospital  Records  344 

Hospital  Staff  Privileges  345 

House — Special  Meetings  of  345 

Immunization  Programs  345 

Impartial  Medical  Testimony  345 


Indigent,  The  Care  of  the  345 

Individual  Rights  345 

Insurance  Plans  345 

Journal  Publication  345 

Laboratories  345 

Lay  Employees  and  Prerogatives  345 

Legal  Counsel  345 

Legislation  345 

Mailing  List  346 

Medical  Care,  Provision  of  346 

Medical  Representation  in  Government 

Planning 346 

Membership  in  Paramedical  & Service 

Organizations  346 

Membership  for  Osteopaths  346 

Mental  Health  346 

Shortage  of  Nurses  346 

Occupational  Health  346 

Osteopaths,  Association  with  346 

Placement  Service  346 

Policy  Statement  346 

Polls,  Opinion  346 

Prepayment  Plans  & Organizations  346 

Press  347 

Publication  of  Research  Data  347 

Public  Affairs  347 

Public  Aid  347 

Public  Health  Departments  347 

Public  Safety  347 

Rebates  347 

Reference  Committee  Appointments  347 

Reference  Service  347 

Rehabilitation  347 

Relative  Value  347 

Specialty  Society  Representation 

on  ISMS  Councils  348 

Stationery,  Use  of  Official  348 

Surveys 348 

Veterans  Administration  348 

Woman’s  Auxiliary  348 


348 


Illinois  Medical  Journal 


ISMS  Officials 

Officers 


President,  J.  Ernest  Breed 

55  E.  Washington  St.,  Chicago,  60602 
President-Elect,  L.  T.  Fruin 

5 Citizen’s  Square,  Normal  61761 


Board  of  Trustees 

1st  District — Joseph  L.  Bordenave 

1665  South  St.,  Geneva  60134  1971 

2nd  District — Wm.  A.  McNichols,  Jr., 

101  W.  1st  St.,  Dixon  61021  1971 

3rd  District — Wm.  M.  Lees 


6518  N.  Nokomis,  Lincolnwood  60646  ..1971 
Frank  J.  Jirka,  Jr. 

1507  Keystone  Ave.,  River  Forest  60305  1971 


James  B.  Hartney 

410  Lake  St.,  Oak  Park  60302  1973 

Warren  W.  Young, 

10816  Parnell  Ave.,  Chicago  60628  1972 

Fredric  D.  Lake 

1041  Michigan  Ave.,  Evanston  60202  ....1972 
Frederick  E.  Weiss 

15643  Lincoln,  Flarvey  60426  1973 

4th  District — Fred  Z.  White 

723  N.  Second  St.,  Chillicothe  61523  ...1973 
5th  District — A.  Edward  Livingston 

219  N.  Main,  Bloomington  61701  1973 

6th  District — Mather  Pfeiffenberger 

State  & Wall  Sts.,  Alton  62002  1972 

7th  District — Arthur  F.  Goodyear 

142  E.  Prairie  Ave.,  Decatur  62523  1970 

8th  District — Eugene  P.  Johnson 

22  W.  Main  St.,  Casey  62420  1973 

9th  District — Charles  K.  Wells 

117  N.  10th  St.,  Mt.  Vernon  62864  1972 

10th  District — Willard  C.  Scrivner 

4601  State  St.,  E.  St.  Louis  62205  1972 

11th  District — Joseph  R.  O’Donnell 

444  Park,  Glen  Ellyn  60137  1971 

Trustee-at-Large,  Edward  W.  Cannady 

4601  State  St.,  East  St.  Louis  62205  1971 

Past  Presidents 

Everett  P.  Coleman  1945-1946 

Edward  W.  Cannady  1970 

Newton  DuPuy  1968 

Harlan  English  1964 

Edwin  S.  Hamilton  1962 

H.  Close  Hesseltine  1961 

James  H.  Hutton  1940 

Willis  I.  Lewis  1954 

George  F.  Lull  1963 

Burtis  E.  Montgomery  1966 

Edward  A.  Piszczek  1965 

Caesar  Portes  1967 

Leo  P.  A.  Sweeney  1953 

Philip  G.  Thomsen  1969 

Arkell  M.  Vaughn  1955 


Secretary-Treasurer,  Jacob  E.  Reisch 
1129  S.  2nd  St.,  Springfield  62704 
Speaker  of  the  House,  Paul  W.  Sunderland 
214  N.  Sangamon  St.,  Gibson  City  60936 

Ex-Officio  Members  of  the  House 
Without  the  Right  to  Vote 
Past  Trustees 

William  E.  Adams 

Chicago,  Trustee  from  the  3rd  District 
Earl  H.  Blair 

Chicago,  Trustee  of  the  3rd  District 
Walter  C.  Bornemeier 

Chicago,  Trustee  of  the  3rd  District 
Carl  E.  Clark 

Sycamore,  Trustee  from  the  1st  District 
Willard  W.  Fullerton 
Sparta,  Trustee  from  the  10th  District 
George  E.  Giffin 

Princeton,  Trustee  from  the  2nd  District 
Lee  N.  Hamm 

Lincoln,  Trustee  from  the  5th  District 
George  A.  Hellmuth 

Chicago,  Trustee  from  the  3rd  District 
Bernard  Klein 

Joliet,  Trustee  from  the  11th  District 
Ted  LeBoy 

Chicago,  Trustee  from  the  3rd  District 
Warner  H.  Newcomb 

Jacksonville,  Trustee  from  the  6th  District 
Ralph  N.  Redmond 

Peoria,  Trustee  from  the  4th  District 
Paul  P.  Youngberg 

Moline,  Trustee  from  the  4th  District 
Darrell  H.  Trumpe 

Trustee  from  the  5th  District 
Wm.  H.  Schowengerdt 

Champaign,  Trustee  from  the  8th  District 

Past  Speakers 

Walter  C.  Bornemeier,  Chicago  1961-1964 

Edward  W.  Cannady,  E.  St.  Louis  1964-1967 

General  Officers  of  the  AMA 

Walter  C.  Bornemeier 
AMA  President 
Burtis  E.  Montgomery 

Member,  Board  of  Trustees 

Vice  Presidents  of  the  ISMS 

George  Shropshear,  First  Vice  President 
C.  J.  Jannings  III,  Second  Vice  President 

Vice  Speaker  of  the  ISMS  House  of  Delegates 
Andrew  J.  Brislen 

(Except  when  presiding  as  Speaker) 


A complete  listing  of  delegates  and  alternates  to  the  ISMS  will 
appear  with  the  convention  program 


for  October,  1970 


349 


AMA  Delegation 


DELEGAl  ES  TO  THE 
AMERICAN  MEDICAL 
ASSOCIATION 

Elected  May  21,  1968 

(to  serve  from  Jan.  1,  1969  to  Dec.  31,  1970) 
MAURICE  M.  HOELTGEN 

1836  West  87th  Street,  Chicago  60620 
LEO  P.  A.  SWEENEY 

10400  S.  Western  Avenue,  Chicago  60643 
H.  CLOSE  HESSELTINE 

5807  South  Dorchester,  Chicago  60637 
WILLIAM  K.  FORD 

303  North  Main  Street,  Rockford  61101 
JACOB  E.  REISCH 

1129  South  2nd  Street,  Springfield  62704 


Elected  May  21,  1969 

(to  serve  from  Jan.  1,  1970  to  Dec.  31,  1971) 
EDWARD  A.  PISZCZEK 

6410  North  Leona,  Chicago  60646 
HAROLD  A.  SOFIELD 

715  Lake  Street,  Oak  Park  60301 
PHILIP  G.  THOMSEN 

13826  Lincoln,  Dolton  60419 
THEODORE  GREVAS 

1800  Third  Avenue,  Rock  Island  61201 
HARLAN  ENGLISH 

909  North  Logan  Avenue,  Danville  61833 
EDWARD  W.  CANNADY 

4601  State  Street,  East  St.  Louis  62205 


Elected  May  20,  1970 

(to  serve  from  Jan.  1,  1971  to  Dec.  31,  1972) 
Maurice  M.  Hoeltgen 
Francis  W.  Young 
H.  Close  Hesseltine 
Carl  E.  Clark 
Joseph  R.  Mallory 


Honorary  Delegates 

Edwin  S.  Hamilton,  151  N.  Schuyler  Street, 
Kankakee  60901 

George  F.  Lull,  2440  Lakeview  Ave.,  Chicago 
60614 


Burtis  E.  Montgomery,  37  South  Main  Street, 
Harrisburg  62946 

Walter  C.  Bomemeier,  4665  Peterson  Avenue, 
Chicago  60646 
Delegate — AMA  Section 
Henry  A.  Holle,  1350  N.  Lake  Shore  Drive, 
Chicago  60610 


ALTERNATE  DELEGATES 
TO  THE  AMERICAN 
MEDICAL  ASSOCIATION 

Elected  May  21,  1968 

(to  serve  from  Jan.  1,  1969  to  Dec.  31,  1970) 
THEODORE  R.  VAN  DELLEN 

1000  Lake  Shore  Plaza,  Chicago  60611 
ALLISON  L.  BURDICK,  SR. 

5906  West  North  Avenue,  Chicago  60639 
ARKELL  M.  VAUGHN 

9012  S.  Leavitt  Street,  Chicago  60620 
PAUL  A.  DAILEY 

620  N.  Main  St.,  Carrollton  62016 
JACK  GIBBS 

Coleman  Clinic,  Canton  61520 


Elected  May  21,  1969 

(to  serve  from  Jan.  1,  1970  to  Dec.  31,  1971) 
HERSCHEL  BROWNS 

4600  North  Ravenswood  Ave.,  Chicago  60640 
GEORGE  C.  TURNER 

6627  Ponchartrain  Avenue,  Chicago  60646 
WILLIAM  M.  LEES 

6518  N.  Nokomis,  Lincolnwood  60646 
MORGAN  M.  MEYER 

573  South  Lombard,  Lombard  60148 
BOYD  McCracken 

100  N.  Locust  St.,  Greenville  62246 
GLEN  E.  TOMLINSON 

4 Lincoln  Professional  Park,  Lincoln  62656 


Elected  May  20,  1970 

(to  serve  from  Jan.  1,  1971  to  Dec.  31,  1971) 
Theodore  R.  VanDellen 
Fred  R.  Tworoger 
Frank  J.  Jirka,  Jr. 

Joseph  R.  O’Donnell 
Jack  Gibbs 


350 


Illinois  Medical  Journal 


OFFICERS  OF  COUNTY  MEDICAL  SOCIETIES 

1970 


Adams  County 
President:  Merle  F.  Crossland 
Quincy  Clinic,  Quincy  62301 
Secretary:  Julio  delCastillo 

Illinois  Bank  Bldg.,  Rm.  712,  Quincy  62301 
Members:  76— District  No.  6 

Alexander  County 
President:  Louis  Ent 
309  8th  St.,  Cairo  62914 
Secretary:  Charles  L.  Yarbrough 

800Vi  Commercial  Ave.,  Cairo  62914 
Members:  6— District  No.  10 

Bond  County 
President:  Charles  R.  Daisy 
308  W.  College  Ave.,  Greenville  62246 
Secretary:  James  Goggin 

207  North  Second,  Greenville  62246 
Members:  6— District  No.  7 

Boone  County 
President:  Wesley  B.  Oliver 

119  South  State  St.,  Belvidere  61108 
Secretary:  Earl  S.  Davis 

119  South  State  St.,  Belvidere  61108 
Members:  19— District  No.  1 

Bureau  County 
President:  Louis  D.  Tarsinos 
682  E.  Peru,  Princeton  61356 
Secretary:  Karl  D.  Nelson 

101  Park  Ave.,  Princeton  61356 
Members:  28— District  No.  2 

Carroll  County 
President:  K.  H.  Reddies 

Savanna  Medical  Center,  333  Chicago  Ave., 
Savanna  61074 
Secretary:  E.  P.  Mitchell 
Shannon  61078 
Members:  9— District  No.  1 

Cass  County 
President:  R.  A.  Spencer 

115  West  4th  Street,  Beardstown  62618 
Secretary:  A.  G.  Hyde 
507  Washington  Street,  Beardstown  62618 
Members:  9— District  No.  6 

Champaign  County 
President:  W.  Petersen 
401  East  Springfield  Ave.,  Champaign  61820 
Secretary:  H.  E.  Wachter 

Christie  Clinic,  Champaign  61820 
Members:  176— District  No.  8 

Chicago  Medical  Society  See  page  356. 

Christian  County 
President:  W.  S.  Miller 
205  N.  Chestnut  Street,  Assumption  62510 
Secretary:  J.  W.  Murphy 

301  S.  Webster  Street,  Taylorville  62568 
Members:  16— District  No.  7 


Clark  County 
President:  Eugene  P.  Johnson 
Casey  62410 

Secretary:  Charles  C.  Moore,  Jr. 

Martinville  Clinic,  Martinville  62442 
Members:  5— District  No.  8 

Clay  County 
President:  A.  Paul  Naney 
Flora  Clinic,  Flora  62839 
Secretary:  Donald  L.  Bunnell  "A. 

Flora  Clinic,  Flora  62839 
Members:  7— District  No.  7 

Clinton  County 
President:  Robert  D.  Roane 
630  9th  Street,  Carlyle  62231 
Secretary:  F.  H.  Ketterer 

289  N.  Main  Street,  Breese  62230 
Members:  11— District  No.  7 

Coles-Cumberland  County 
President:  L.  E.  Massie 
Toledo  62468 

Secretary:  Mack  W.  Hollowell 

35  Circle  Drive,  Charleston  61920 
Members:  37— District  No.  8 

Crawford  County 
President:  Charles  N.  Maples 
408  West  Walnut,  Robinson  62454 
Secretary:  W.  B.  Schmidt, 

408  S.  Cross,  Robinson  62454 
Members:  13— District  No.  8 

De  Kalb  County 
President:  Wilbur  Thompson 
815  South  2nd  Street,  DeKalb  60115 
Secretary:  Frank  Luedtke 

DeKalb  Clinic,  DeKalb  60115 
Members:  52— District  No.  1 

De  Witt  County 
President:  John  W.  Veirs 
219  East  Main  St.,  Clinton  61727 
Secretary:  Charles  Ramey 

215  East  Main  St.,  Clinton  61727 
Members:  10— District  No.  5 

Douglas  County 
President:  Grant  A.  Jones 
318  S.  Ash  St.,  Arthur  61911 
Secretary:  Elmer  S.  Allen 

120  S.  Locust  St.,  Areola  61910 
Members;  11— District  No.  8 

Du  Page  County 
President:  William  B.  Frymark 
40  S.  Clay  St.,  Hinsdale  60521 
Secretary:  James  P.  Campbell 

322  N.  Blanchard  St.,  Wheaton  60187 
Executive  Secretary:  Lillian  Widmer 
646  Roosevelt  Road,  Glen  Ellyn  60137 
Members:  373— District  No.  11 


for  October,  1970 


.35! 


Edgar  County 

President:  Joseph  R.  Shackelford 
Medical  Center  Clinic,  Paris  61944 
Secretary;  J.  M.  Ingalls 

Medical  Center  Clinic,  Paris  61944 
Members:  15— District  No.  8 

Edwards  County 
President:  Paul  S.  Neirenberg 
7 West  Main  St.,  Albion  62806 
Secretary:  Andrew  Krajec 
Box  336,  West  Salem  62476 
Members:  2— District  No.  9 

Effingham  County 
President:  Henry  Runde 
Teutopolis  62467 
Secretary:  Delbert  Hiielskoetter 
Altamont  62411 
Members;  25— District  No.  7 

Fayette  County 
President:  J.  H.  Weiner 
5031/2  Gallatin,  Vandalia  62471 
Secretary:  E.  A.  Kiiehn 

5OIV2  West  Gallatin,  Vandalia  62471 
Members;  11— District  No.  7 


Ford  County 
President:  Clyde  A.  Rulison 
Roberts  60962 

Secretary:  William  A.  Garrett 
Sibley  61773 

Members:  13— District  No.  11 

Franklin  County 
President:  Carl  Allinson 
P.O.  Box  156.  Benton  62812 
Secretary:  David  P.  Richerson 
217  East  Broadway,  Johnston  City  62951 
Members;  21— District  No.  9 

Fulton  County 
President:  W.  K.  Wilner,  Jr. 

Box  423,  Canton  61520 
Secretary;  O.  M.  Wood 
Ipava  61441 

Members;  24— District  No.  4 

Gallatin  County 
President:  Joe  Bryant 
Ridgway  62979 
Secretary:  John  Doyle 
Ridgway  62979 
Members;  3— District  No.  9 

Greene  County 
President:  Paul  A.  Dailey 
620  N.  Main  St.,  Carrollton  62016 
Secretary:  James  C.  Reid 

Pillager  Memorial  Clinic,  Greenfield  62044 
through  September,  1970 
Members:  9— District  No.  6 


Hancock  County 
President:  Christian  W.  Bruehsel 
Warsaw  Clinic,  Warsaw  62379 
Secretary:  Use  Erika  Bruehsel 
Warsaw  Clinic,  Warsaw  62379 
Memljers:  10— District  No.  4 

Henderson  County 
President;  Harold  L.  Bock 
Box  338,  Stronghurst  61480 
Secretary:  Silvino  Lindo,  Jr. 

Biggsville  61448 
Members:  2— District  No.  4 

Henry-Stark  County 
President:  Hans  Phillips 

Kewanee  Medical  Center,  Kewanee  61443 
Secretary:  Luis  J.  Garcia 

Kewanee  Public  Hospital,  Kewanee  61443 
Members:  32— District  No.  4 

Iroquois  County 
President:  Cliff  L.  Clark 

125  East  Grove  St.,  Sheldon  60966 
Secretary:  Bela  Borsos 
207  N.  Axtel  Ave.,  Milford  60953 
through  December,  1970 
Members:  18— District  No.  11 

Jackson  County 
President;  Dan  B.  Foley 

103  S.  Washington,  Carbondale  62901 
Secretary:  Homer  H.  Hanson 

Carbondale  Clinic,  Box  1030,  Carbondale  62901 
Members:  50— District  10 

Jasper  County 
President:  Don  Hartrich 
Box  192,  Newton  62448 
Secretary:  C.  O.  Absher 
Newton  62448 
Members:  3— District  No.  8 

Jefferson-Hamilton  County 
President:  R.  H.  Garretson 
26  Wildwood  Road,  Mt.  Vernon  62864 
Secretary:  R.  J.  Dancey 

State  TB  Sanitarium.  Mt.  Vernon  62864 
Members:  28— District  No.  9 

Jersey-Calhoun  County 

President:  Herman  E.  Wuestenfeld 
300  S.  W'ashington  St.,  Jerseyville  62052 
Secretary;  C.  Maxwell  Brown 
2 Campus  Drive,  Hardin  62047 
Members:  10— District  No.  6 

Jo  Daviess  County 
President:  C.  George  Ward 

153  East  Main  St.,  Warren  61087 
Secretary;  Delbert  O.  W'illiams,  Jr. 

323  N.  Main  St.,  Stockton  61085 
Members:  10— District  No.  1 

Johnson  County 

Members:  1— District  No.  9 


352 


Illinois  Medical  Journal 


Kane  County 
President:  A.  G.  Baxter 
34  N.  Water  St.,  Batavia  60510 
Secretary:  A.  Beaumont  Johnson 
860  Summit  St.,  Elgin  60120 
Executive  Director:  Michael  Fitzgerald 
17  N.  Sixth  St.,  Geneva  60134 
Members:  249— District  No.  1 

Kankakee  County 
President:  James  H.  Geist 
Rt.  #5.  Box  11,  Kankakee  60901 
Secretary:  Herbert  P.  Swartz 
450  Kennedy  Drive,  Kankakee  60901 
Members:  89— District  No.  11 

Kendall  County 
President:  Stefan  Wojtowycz 
8 East  Main,  Plano  60545 
Secretary:  Victor  H.  Smith 
Johnson  St.,  Newark  60541 
Members:  8— District  No.  11 

Knox  County 
President:  G.  W.  Douglas 
320  N.  Kellogg  St.,  Galesburg  61401 
Secretary:  K.  K.  Kleinkauf 

311  East  Main  St.,  Galesburg  61401 
Members:  64— District  No.  4 

Lake  County 
President:  Richard  Hawkins 
535  West  Park  Ave.,  Libertyville  60048 
Secretary:  Richard  Dolan 

716  S.  Milwaukee  Ave.,  Libertyville  60048 
Executive  Secretary:  Mrs.  Julia  P.  Schulz 
P.O.  Box  148,  Gurnee  60031 
Members:  261— District  No.  1 

La  Salle  County 
President:  Robert  W.  Rieman 
313  West  Madison  St.,  Ottawa  61350 
Secretary:  Allan  L.  Goslin 

712  N.  Bloomington,  Streator  61364 
Members:  98— District  No.  2 

Lawrence  County 
President:  Robert  J.  Nichols 
P.O.  Box  907,  Vincennes,  Indiana  47591 
Secretary:  Charles  G.  Stoll 

802  Jefferson  St.,  Lawrenceville  62439 
Executive  Secretary:  Ruth  E.  Gariepy 

Lawrence  Cty.  Mem.  Hospital,  Lawrenceville  62439 
Members:  10— District  No.  8 

Lee  County 
President:  R.  Silve 

120  West  South  St.,  Franklin  Grove  61031 
Secretary:  George  Silvest 

114  East  Everett  Ave.,  Dixon  61021 
Members:  20— District  No.  2 

Livingston  County 
President:  Harold  Schroder 
117  N.  Mill  St.,  Pontiac  61764 
Secretary:  Karl  T.  Deterding 

Bank  of  Pontiac  Bldg.,  Pontiac  61764 
Members:  28— District  No.  2 


Logan  County 
President:  Gilbert  E.  Blaum 

1301  Rutledge  St.,  Lincoln  62656 
Secretary:  Glen  E.  Tomlinson 

4 Lincoln  Prof.  Park,  Lincoln  62656 
Members:  21— District  No.  5 

Macon  County 
President:  Richard  E.  Kinzer 
2300  N.  Edward,  Decatur  62525 
Secretary:  Charles  O.  Stanley 
417  West  Wood  St.,  Decatur  62522 
Executive  Secretary:  Mary  J.  Bretz 

1800  East  Lake  Shore  Drive,  Decatur  62521 
Members:  134— District  No.  7 

Macoupin  County 
President:  James  C.  Hawkins 

103  East  Main  St.,  Staunton  62088 
Secretary:  Robert  H.  Rutherford 
224  East  Main  St.,  Carlinville  62626 
Members:  22— District  No.  6 

Madison  County 
President:  Richard  Yoder 
601  East  3rd  St.,  Alton  62002 
Secretary:  Leo  Green 

1114  Milton  Road,  Alton  62002 
Members:  125— District  No.  6 

Marion  County 
President:  Badih  Chagerben 

620  Pleasant  Ave.,  Centralia  62801 
Secretary:  Walter  P.  Plassman 
Box  552,  Centralia  62801 
Members:  35— District  No.  7 

Mason  County 
President:  Dario  Landazuri 

125  N.  Orange  St.,  Havana  62644 
Secretary:  Henry  W.  Maxfield 
Mason  City  62664 
Members:  8— District  No.  5 

Massac  County 
President:  James  L.  Bremer 
805  Market  St.,  Metropolis  62960 
Secretary:  Ralph  K.  Frazier 

Hospital  Drive,  Metropolis  62960 
Members:  8— District  No.  9 

McDonough  County 
President:  L.  O.  Vida 
501  East  Grant,  Macomb  61455 
Secretary:  J.  L.  Symmonds 

301  East  Jefferson.  Macomb  61455 
Members:  23— District  No.  4 

McHenry  County 
President:  Mladen  Mijanovich 
556  East  Grant  St.,  Marengo  60152 
Secretary:  Vincenzo  Petralia 

210  Northwest  Highway,  Fox  River  Grove  60021 
Executive  Secretary:  Evelyn  Rosulek 
308  Kimball  Ave.,  Woodstock  60098 
Members:  62— District  No.  1 


for  October,  1970 


353 


McLean  County 
President:  Rita  Walsh 
429  N.  Main,  Bloomington  61701 
Secretary:  George  Shonat 
429  N.  Main,  Bloomington  61701 
Executive  Secretary:  David  W.  Meister 
429  N.  Main  St.,  Bloomington  61701 
Members:  82— District  No.  5 

Menard  County 
President:  Robert  J.  Schafer 

116  N.  5th  St.,  Petersburg  62675 
Secretary:  H.  K.  Moidton 

119  N.  7th  St.,  Petersburg  62675 
Members:  4— District  No.  5 

Mercer  County 
President:  R.  N.  Svendsen 
209  S.  College  Ave.,  Aledo  61231 
Secretary:  James  W.  Hastings 
301  NW  2nd  St.,  Aledo  61231 
Members:  5— District  No.  4 

Monroe  County 
President:  Russell  W.  Jost 

107  East  4th  St..  Waterloo  62298 
Secretary:  Joseph  Werth 
Box  127,  Waterloo  62298 
Members:  8— District  No.  10 

Montgomery  County 
President:  Nelson  K.  Floreth 
416  N.  Monroe  St.,  Litchfield  62056 
Secretary:  D.  Ross  Billiter 

616  N.  Walnut,  Litchfield  62056 
Members:  16— District  No.  5 

Morgan-Scott  County 
President:  Albert  F.  Fricke 
216  S.  Church,  Jacksonville  62650 
Secretary:  Robert  H.  Kooiker 

801  Lincoln  Ave.,  Jacksonville  62650 
Members:  38— District  No.  6 

Moultrie  County 
President:  Eugene  Boros 
Bethany  61914 
Secretai7:  H.  E.  Kendall 

112  East  Harrison,  Sullivan  61951 
Members:  5— District  No.  7 

Ogle  County 
President:  Franklin  D.  Swan 
104  N.  5th  St.,  Oregon  61061 
Secretary:  Russell  Zack 
515  Lincoln  Hwy.,  Rochelle  61068 
Members:  23— District  No.  1 

Peoria  County 
President:  Ward  H.  Eastman 
427  1st  National  Bank  Bldg.,  Peoria  61602 
Secretary:  Dean  R.  Bordeaux 

427  1st  National  Bank  Bldg.,  Peoria  61602 
Executive  Secretary:  David  W.  Meister 
427  1st  National  Bank  Bldg.,  Peoria  61602 
Members:  232— District  No.  4 


Perry  County 
President:  Byford  I.  Hall 
701  N.  Washington  St.,  DuQuoin  62832 
Secretary:  Billy  R.  Fulk 
P.O.  Box  245,  DuQuoin  62832 
Members:  16— District  No.  10 

Piatt  County 
President:  George  Green 
340  N.  State  St.,  Monticello  61856 
Secretary:  Joseph  Allman 

121  N.  State  St.,  Monticello  61856 
Members:  6— District  No.  7 

Pike  County 
President:  A.  C.  Schewe 
203  N.  Madison,  Pittsfield  62363 
Secretai7:  B.  J.  Rodriguez 
880  Bainbridge  St.,  Bari7  62312 
Members:  9— District  No.  6 

Pulaski  County 
President:  A.  L.  Robinson 
Box  277,  Mounds  62964 
Secretary:  Marvin  F.  Powers 

107-A  S.  Oak  St.,  Mounds  62964 
Members:  2— District  No.  10 

Randolph  County 
President:  Ralph  Kuhlman 
824  S.  Locust  St.,  Red  Bud  62278 
Secretary:  C.  S.  Schlageter 
101  N.  Market,  Sparta  62286 
Members:  18— District  No.  10 

Richland  County 
President:  G.  Harrison 
600  East  Main  St.,  Olney  62450 
Secretary:  T.  Martin 

Weber  Medical  Clinic,  Olney  62450 
Members:  24— District  No.  8 

Rock  Island  County 
President:  Billie  Shevick 
729  3rd  Ave.,  Moline  61265 
Secretary:  Newell  T.  Braatelien 

Moline  Public  Hospital,  Moline  61201 
Executive  Secretary:  James  A.  Koch 
612  Kahl  Building,  Davenport,  Iowa  52801 
Members:  146— District  No.  4 

St.  Clair  County 
President:  Stuart  W.  Mauch 
301  W.  Lincoln  St.,  Suite  106,  Belleville  62221 
Secretary:  Peter  Soto 

St.  Elizabeth’s  Hospital,  Belleville  62221 
Executive  Director:  Ed  Belz 
4825  West  Main  St.,  Belleville  62223 
Members:  188— District  No.  10 

Saline-Pope-Hardin  County 
President:  John  E.  Choisser 
Box  C,  Harrisburg  62946 
Secretary:  Warren  R.  Dammers 
Box  281,  Harrisburg  62946 
Members:  26— District  No.  9 


354 


Illinois  Medical  Journal 


Sangamon  Coun  i y 
President:  Howard  Penning 
1315  N.  5th  St.,  Springfield  62702 
Secretary:  John  M.  Holland 
700  N.  7th  St.,  Springfield  62702 
Executive  Secretary:  L.  R.  Brosi 
2100  Lindsay  Road,  Springfield  62704 
Members:  215— District  No.  5 

Schuyler  County 
President:  R.  R.  Dohner 

103  W.  Washington,  Rushville  62681 
Secretary:  Henry  C.  Zingher 

Rushville  Clinic,  Rushville  62681 
Members:  4— District  No.  4 

Shelby  County 
President:  Harvey  H.  Pettry 
407  West  Main  St.,  Shelbyville  62565 
Secretary:  Smith  D.  Taylor 
520  Penns  Ave.,  Windsor  61957 
Members:  8— District  No.  7 

Stephenson  County 
President:  William  Katel 
222  West  Exchange  St.,  Freeport  61032 
Secretary:  R.  Samuel  Hoover 
Box  573,  Freeport  61032 
Members:  37— District  No.  1 

Tazewell  County 
President:  Erik  Maran 
427  1st  National  Bank  Bldg.,  Peoria  61602 
Secretary:  Robert  M.  Wright 

427  1st  National  Bank  Bldg.,  Peoria  61602 
Executive  Secretary:  David  W.  Meister 
427  1st  National  Bank  Bldg.,  Peoria  61602 
Members:  46— District  No.  5 

Union  County 

President:  William  H.  Whiting 
Box  410,  Anna  62906 
Secretary:  William  H.  Whiting 
410  Anna  62906 
Members:  7— District  No.  10 

Vermilion  County 
President:  A.  R.  Matteson 

101  W.  North  St.,  Danville  61832 
Secretary:  L.  W.  Tanner 

7 N.  Virginia,  Danville  61832 
Members:  88— District  No.  8 

Wabash  County 
President:  T.  R.  Young 
512  Market  St.,  Mount  Carmel  62863 
Secretary:  C.  J.  Johns 

114  West  5th  St.,  Mt.  Carmel  62863 
Members:  7— District  No.  9 

Warren  County 
President:  Joseph  Simmons 
Kirkwood  61447 

Secretary:  Glenn  W.  Chamberlin 
219  East  Euclid  St.,  Monmouth  61462 
Members:  11-District  No.  4 


Washington  County 
President:  Charles  W.  Longwell 

111  South  Washington,  Nashville  62263 
Secretary:  Jerry  L.  Beguelin 
Box  197,  Irvington  62848 
Members:  4— District  No.  10 

Wayne  County 
President:  C.  J.  Jannings 

101  East  Center,  Fairfield  62837 
Secretary:  S.  W.  Konarski 

101  East  Center  Fairfield  62837 
Members:  7— District  No.  9 

White  County 

President:  William  H.  Courtnage 
Carmi  Medical  Center,  Carmi  62821 
Secretary:  Phillip  D.  Boren 
South  Plum  St.,  Carmi  62821 
Members:  7— District  No.  9 

Whiteside  County 
President:  Darroll  J.  Erickson 
Sterling— Rock  Falls  Clinic 
101  East  Miller  Road,  Sterling  61081 
Secretary:  John  F.  Hubbard 

110  Dixon  Ave.,  Rock  Falls  61071 
Members:  41— District  No.  2 

Will-  Grundy  County 
President:  Ernest  F.  Kreutzer 
719  Catherine  St.,  Joliet  60435 
Secretary:  Frederick  C.  Bauer 
600  Walnut  St.,  Joliet  60432 
Executive  Secretary:  Don  M.  Kline 
58  N.  Chicago  St.,  Room  201,  Joliet  60431 
Members:  188— District  No.  11 


Williamson  County 
President:  Roger  Hendricks 
121  N.  13th  St.,  Herrin  62948 
Secretary:  H.  V.  Fine 

110  N.  Division  St.,  Carterville  62918 
Members:  30— District  No.  9 

Winnebago  County 
President:  John  P.  McHugh 
2623  Edgemont  St.,  Rockford  61103 
Secretary:  Donald  P.  Feeney 
2300  N.  Rockton  Ave.,  Rockford  61101 
Executive  Adm.:  Donald  A.  Westbrook 
310  N.  Wvman  St.,  Rockford  61101 
Members:  277— District  No.  1 

Woodford  County 
President:  Joseph  C.  Phifer 
203  S.  Main  St.,  Eureka  61530 
Secretary:  James  Riley 

109  S.  Major  St.,  Eureka  61530 
Members:  10— District  No.  2 


No  Organized 
County  Society 
Brown 
Johnson 
Marshall 
Putnam 


Joint  County  Societies 
Coles-Cumberland 
Henry-Stark 
Jefferson-Hamilton 
Jersey-Calhoun 
Morgan-Scott 
Saline-Pope-Hardin 
Will-Giundv 


for  October,  1970 


Chicago  Medical  Society 

President:  William  E.  Adams 
55  E.  Erie  Street,  Chicago  60611 
President-Elect:  Andrew  J.  Brislen 
6060  S.  Drexel  Blvd.,  Chicago  60637 
Secretary:  Charles  P.  McCartney 
950  E.  59th  Street,  Chicago  60637 
Treasurer:  H.  Kenneth  Scatliff 

310  S.  Michigan  Ave.,  Chicago  60604 
Executive  Vice-President:  George  F.  Lull 
310  S.  Michigan  Ave.,  Chicago  60604 
Executive  Director:  Robert  J.  Bindley 
310  S.  Michigan  Ave.,  Chicago  60604 
Members:  6,441— District  No.  3 

Branch  Officers 
Aux  Plaines  Branch 

President:  Martin  W.  Green 

7579  West  Lake  St.,  River  Forest  60305 
Secretary-Treasurer:  Robert  C.  Muehrcke 
518  N.  Austin  Blvd.,  Oak  Park  60303 
Calumet  Branch 

President:  Thomas  S.  Patricoski 
11110  S.  Sawyer  Ave.  60655 
Secretary:  Elizalieth  Hemmons 
11049  S.  Fairfield  Ave.  60655 
Douglas  Park  Branch 

President:  Ben  E.  Wagner 
6729  Stanley  Ave.,  Berwyn  60402 
Secretary-Treasurer:  Kent  F.  Borkovec 
3340  S.  Oak  Park  Ave.,  Berwyn  60402 
Englewood  Branch 

President:  George  A.  Dejong 
4391  West  95th  St.,  Evergreen  Pk.  60642 
Secretary-Treasurer:  Thomas  Peter  Driscoll 
2800  W.  87th  St.  60652 
North  Suburban  Branch 

President:  Lawrence  J.  Lawson,  Jr. 

636  Church  St.,  Evanston  60204 
Secretary-Treasurer:  Stanley  E.  Huff 
636  Church  St.,  Evanston  60204 
Irving  Park  Suburban  Branch 
President:  Lawrence  L.  Hirsch 
836  Wellington  60657 
Secretary:  Vincent  C.  Sarley 
811  W.  Wellington  Ave.  60614 


Jackson  Park  Branch 

President:  Albert  B.  Lorincz 
5841  S.  Maryland  Ave.  60637 
Secretary-Treasurer:  Matthew  W.  Kobak 
5555  S.  Everett  Ave.  60637 
North  Shore  Branch 

President:  Rocco  V.  Lobraico 
4833  W.  Peterson  Ave.  60646 
Secretary:  William  O.  Ackley 
2439  W.  Foster  Ave.  60625 
North  Side  Branch 

President:  I.  Pat  Bronstein 
30  N.  Michigan  Ave.  60602 
Secretary-Treasurer:  Joseph  C.  Sherrick 
303  E.  Superior  St.  60611 
Northwest  Branch 

President:  E.  J.  Kotanyi 
1174  N.  Milwaukee  Ave.  60622 
Secretary-Treasurer:  Alfonso  Diaz 
1802  S.  Racine  Ave.  60608 
South  Chicago  Branch 

President:  Thomas  S.  Bernat 
624  West  31st  St.  60616 
Secretary-Treasurer:  Anthony  Cesare 
9204  Commercial  Ave.  60617 
South  Side  Branch 

President:  Kermit  T.  Mehlinger 
4901  S.  Drexel  Blvd.  60615 
Secretary:  Otto  J.  Keller 
5825  S.  Dorchester  Ave.  60637 
Southern  Cook  County  Branch 
President:  John  E.  Driscoll 

18109  Dixie  Hwy.,  Homewood  60430 
Secretary-Treasurer:  Paul  P.  David 
159  E.  144th  St.,  Riverdale  60627 
Stock  Yards  Branch 

President:  Maurice  M.  Hoeltgen 
1836  West  87th  St.  60620 
Secretary-Treasurer:  Edwin  J.  Lukaszewski 
1213  W.  51st  St.  60609 
West  Side  Branch 
President:  Anna  A.  Marcus 
5852  West  North  Ave.  60639 
Secretary-Treasurer:  William  J.  Tansey 
414  S.  Oak  Park  Ave.,  Oak  Park  60303 


356 


Illinois  Medical  Journal 


for  October,  1970 


357 


TRUSTEE  DISTRICT  COMMITTEES 


First  District 

Joseph  L.  Bordenave,  Geneva,  Trustee 
Counties  of  Boone,  Carroll,  DeKalb,  Jo  Daviess, 
Kane,  Lake,  McHenry,  Ogle,  Stephenson,  Win- 
nebago 

Ethical  Relations  Committee  Term  Expires 


John  H.  Steinkamp,  Belvidere,  Chairman 1972 

Gerald  Liesen,  St.  Charles  1973 

John  W.  Ovitz  Jr.,  Sycamore  1971 

E.  J.  McKinney,  Rockford  1972 

Peer  Review  Committee 

Russell  Zack,  Rochelle,  Chairman  1973 

Kenneth  L.  Morris,  Stockton,  Co-Chairman  1971 

R.  Gregory  Green,  Rockford  1972 

M.  Mijanovich,  Marengo  1971 

Walter  J.  Reedy,  Waukegan  1972 

Jerald  A.  Bowman,  Rockford  1971 

John  E.  Madden,  Freeport  1973 

Rodney  Nelson,  Geneva  1972 

Erwin  A.  Schilling,  Rockford  1972 

R.  E.  Whitsitt,  Rockford  1972 

Delbert  O.  Williams,  Jr.,  Stockton  1971 


Second  District 

William  A.  McNichols,  Jr.,  Dixon,  Trustee 
Counties  of  Bureau,  LaSalle,  Lee,  Livingston, 
Marshall,  Putnam,  Whiteside,  Woodford 

Ethical  Relations  Committee  Term  Expires 


K.  Dexter  Nelson,  Princeton,  Chairman  1971 

Ralph  Bailey,  Ottawa  1972 

Tim  Sullivan,  Sterling  1973 

Peer  Review  Committee 

K.  M.  Nelson,  Princeton,  Chairman  1972 

M.  D.  Burnstine,  Sterling,  Co-Chairman  1973 

James  B.  Aplington,  LaSalle  1973 

LaMonte  Ballard,  Sterling  1973 

Francis  J.  Brennan,  Utica  1973 

Silvio  Davito,  Spring  Valley  1973 

Bernard  J.  Doyle,  LaSalle  1973 

Donald  Edwards,  Dixon  1973 

William  Ehling,  Streator  1971 

Julius  Kolis,  Dixon  1973 

P.  Lymberopoulis,  Dixon  1973 

Edward  Murphy,  Dixon  1971 

Rowland  Musick,  Mendota  1973 

Joseph  Phifer,  Eureka  1972 

Goodwin  Taraason,  Peru  1973 

Louis  Tarsinos,  Princeton  1973 


Philip  Terry,  Kewanee  1973 

Theodore  W.  Wagenknecht,  Streator  1973 


Third  District 

Frederick  E.  Weiss,  Chicago,  Trustee 
James  B.  Hartney,  Oak  Park,  Trustee 
Frank  J.  Jirka,  Jr.  River  Forest,  Trustee 
Fredric  D.  Lake,  Evanston,  Trustee 
William  M.  Lees,  Lincolnwood,  Trustee 
Warren  W.  Young,  Chicago,  Trustee 

No  district  committees  are  appointed. 

Fourth  District 

Fred  Z.  White,  Chillicothe,  Trustee 
Counties  of  Fulton,  Hancock,  Henderson,  Henry, 
Knox,  McDonough,  Mercer,  Peoria,  Rock  Is- 
land, Schuyler,  Stark,  Warren 

Ethical  Relations  Committee  Term  Expires 


Richard  Icenogle,  Roseville,  Chairman  1971 

John  Bowman,  Abingdon  1973 

George  Burke,  Rock  Island  1972 

Peer  Review  Committee 

Russell  Jensen,  Monmouth,  Chairman  1973 

William  O.  McQuiston,  Peoria,  Co-Chairman  1972 

F.  A.  Christensen,  Peoria  1972 

William  G.  Neilson,  Kewanee  1972 

James  C.  Parsons,  Geneseo  1973 

Donald  Dexter,  Macomb  1971 


Fifth  District 

A.  Edward  Livingston,  Bloomington,  Trustee 
Counties  of  DeWitt,  Logan,  McLean,  Mason, 
Menard,  Montgomery,  Sangamon,  Tazewell 

Ethical  Relations  Committee  Term  Expires 


William  W.  Curtis,  Springfield,  Chairman  ...,1971 

Arthur  Conklin,  Bloomington  1973 

Jack  Means,  Mason  City  1972 

Peer  Review  Committee 

James  Borgerson,  Mt.  Pulaski,  Chairman  ....1971 

Robert  Price,  Blomington,  Co-Chairman  1971 

Ross  Billiter,  Litchfield  1973 

George  Irwin,  Bloomington  1973 

John  G.  Meyer,  Springfield  1972 

Alton  J.  Morris,  Springfield  1973 

Robert  B.  Perry,  Lincoln  1973 

Robert  Schaefer,  Petersburg  1972 

James  Weiner,  Pekin  1973 


358 


Illinois  Medical  Journal 


Sixth  Uistrict 

Mather  Pfeiffenberger,  Alton,  Trustee 
Counties  of  Adams,  Brown,  Calhoun,  Cass, 
Green,  Jersey,  Macoupin,  Madison,  Morgan, 
Pike,  Scott 

Ethical  Relations  Committee  Term  Expires 


Joseph  J.  Grandone,  Gillespie,  Chairman  ....1971 

Bernard  Baalman,  Hardin  1972 

W.  W.  Bowers,  Granite  City  1973 

Edward  K.  DuVivier,  Alton  1971 

Peer  Review  Committee 

Richard  Cooper,  Quincy,  Chairman  1971 

James  Reid,  Greenfield,  Co-Chairman  1971 

E.  C.  Bone,  Jacksonville  1973 

Jude  A.  Caselton,  Carrollton  1972 

Bruno  DeSulis,  Beardstown  1971 

Robert  R.  Hartman,  Jacksonville  1972 

Robert  C.  Murphy,  Quincy  1973 

Frank  B.  Norbury,  Jacksonville  1972 

Meyer  Shulman,  Pittsfield  1971 


Seventh  District 

Arthur  F.  Goodyear,  Decatur,  Trustee 
Counties  of  Bond,  Christian,  Clay,  Clinton, 
Effingham,  Fayette,  Macon,  Marion,  Moultrie, 
Piatt,  Shelby 

Ethical  Relations  Committee  Term  Expires 


Carl  Sandburg,  Decatur,  Chairman  1973 

Max  Hirschfelder,  Centralia  1971 

E.  H.  Rames,  Vandalia  1972 

Peer  Review  Committee 

Richard  Larson,  Shelbyville,  Chairman  1971 

Boyd  McCracken,  Greenville  1971 

Stanley  Moore,  Vandalia  1973 

Walter  P.  Plassman,  Centralia  1973 

William  Sargeant,  Effingham  1973 


Eighth  District 

Eugene  P.  Johnson,  Casey,  Trustee 
Counties  of  Champaign,  Clark,  Coles,  Crawford, 
Cumberland,  Douglas,  Edgar,  Jasper,  Lawrence, 
Richland,  Vermilion 

Ethical  Relations  Committee  Term  Expires 
Mack  W.  Hollowell,  Charleston,  Chairman  ..1971 


James  H.  Pass,  Olney  1972 

Alan  M.  Taylor,  Danville  1973 

Peer  Review  Committee 

A.  R.  Brandenberger,  Danville,  Chairman  ....1971 

James  W.  Landis,  Olney,  Co-Chairman  1971 

Eugene  Johnson,  Casey  1972 

Gorgon  Sprague,  Paris  1973 

E.  A.  Kendall,  Mattoon  1973 

George  T.  Mitchell,  Marshall  1972 


Ninth  District 

Charles  K.  Wells,  Mt.  Vernon,  Trustee 
Counties  of  Edwards,  Franklin,  Gallatin,  Hamil- 
ton, Hardin,  Jefferson,  Johnson,  Massac,  Pope, 
Saline,  Wabash,  Wayne,  White,  Williamson 


Ethical  Relations  Committee  Term  Expires 

Warren  D.  Tuttle,  Harrisburg,  Chairman  1972 

Philip  Boren,  Carmi  1971 

Andrew  Krajec,  West  Salem  1973 

Peer  Review  Committee 

C.  J.  Jannings,  III,  Fairfield,  Chairman  1973 

Denton  Farrell,  Eldorado,  Co-Chairman  1971 

John  Duffey,  Rosiclare  1971 

Herbert  Fine,  Carterville  1972 

Ernest  Lowenstein,  Mt.  Carmel  1973 

A.  Watson  Miller,  Herrin  1972 


Tenth  District 

Willard  C.  Scrivner,  E.  St.  Louis,  Trustee 
Counties  of  Alexander,  Jackson,  Monroe,  Perry, 
Pulaski,  Randolph,  St.  Clair,  Union, 
Washington 

Ethical  Relations  Committee  Term  Expires 


A.  L.  Robinson,  Mounds,  Chairman 1973 

Harold  McCann,  East  St.  Louis  1971 

William  Borgsmiller,  Murphysboro  1972 

Peer  Review  Committee 

Joseph  A.  Petrazio,  Murphysboro,  Chairman  1973 

George  Cutridge,  DuQuoin,  Co-Chairman  ....1973 

Charles  Baldree,  Belleville  1973 

Eli  Borken,  Carbondale  1973 

R.  W.  Jost,  Waterloo  _...1972 

B.  Kinsman,  DuQuoin  1973 

R.  E.  Schettler,  Red  Bud  1971 

William  H.  Walton,  Belleville  1972 

William  H.  Whiting,  Anna  1971 

Charles  L.  Yarbrough,  Cairo 1973 


Eleventh  District 

Joseph  R.  O’Donnell,  Glenn  Ellyn,  Trustee 
Counties  of  DuPage,  Ford,  Grundy,  Iroquois, 
Kankakee,  Kendall,  Will 

Ethical  Relations  Committee  Term  Expires 


James  Ryan,  Kankakee,  Chairman  1972 

John  Bowden,  Joliet  1973 

Lawrence  D.  Lee,  Manhattan  1973 

Peer  Review  Committee 

James  Campbell,  Wheaton,  Chairman  1972 

James  E.  Dailey,  Watseka  1972 

James  Lambert,  Joliet  1973 

Guy  Pandola,  Joliet  1972 

William  C.  Perkins,  West  Chicago  1973 

Julius  Schweitzer,  Hinsdale  1971 

Victor  Smith,  Newark  1971 


for  October,  1970 


359 


ISMS  Organization 


3G0 


Illinois  Medical  Journal 


Councils  of  the  Illinois  State  Medical  Society 

Committees  of  the  Illinois  State  Medical  Society  are  appointed  by  the  Chairman  of  the  Board  of  Trustees  subject 
to  approval  of  the  Board  of  Trustees,  and  are  assigned  to  one  of  eight  councils.  The  councils  are  similarly  appointed 
and  are  composed  of  committee  chairmen  and  such  other  members  as  are  necessary  to  accomplish  the  purposes  of  the 
council.  Some  committees  are  composed  of  members  of  the  Board  of  Trustees  and  are  designated  Board  Committees. 
Some  committees  may  report  directly  to  the  board  and  are  not  assigned  to  a council.  Task  Forces  are  established  to 
address  a particular  problem  or  concern  which  crosses  areas  of  responsibility  of  the  several  councils.  The  task  forces 
report  directly  to  the  board,  as  do  representatives  to  various  otlier  agencies. 


for  October,  1970 


361 


COUNCIL  ON  ECONOMICS  & PEER  REVIEW 


Glen  E.  Tomlinson,  Chairman 

4 Lincoln  Professional  Park,  Lincoln  62626 
Fred  A.  Tworoger,  Vice-Chairman 
4753  Broadway,  Chicago  60640 
Rex  O.  McMorris 

619  N.E.  Glen  Oak  Ave.,  Peoria  61603 
Charles  E.  Baldree,  Jr. 

26  E.  Washington,  Belleville  62220 
Eli  Borkon 

Carbondale  Clinic,  Carbondale  62901 
Stanley  Bobowski 
407  S.  Fourth,  Champaign  61820 
Edward  DuVivier 

1900  Brown  St.,  Alton  62002 
John  L.  Eaton 
4204-35th  Ave.,  Moline  61265 
Maynard  Shapiro 
7531  Stony  Island,  Chicago  60649 
John  P.  Marty 

1315  N.  5th  St.,  Springfield  62702 
Don  Michels 

533  W.  North.  Elmhurst  60126 
Earl  Walker 

18  Peachtree  Place,  Harrisburg  62946 
R.  Gregory  Green 

1355  Charles  St.,  Rockford  61108 
Robert  Muehrcke 
518  N.  Austin,  Oak  Park  60302 
Hilliard  M.  Shair 

1101  Main  St.,  Quincy  62301 
Reuben  Gaines 

30  N.  Michigan  Ave.,  Chicago  60602 
Clinton  L.  Lindo 

110  East  79th  St.,  Chicago  60619 
Robert  Becker 
58  N.  Chicago,  Joliet  60431 
Burton  Jacobson 

3425  W.  Peterson,  Cbicago  60645 


Consultants 
Fred  Z.  White 

723  N.  Second  Street,  Chillicothe  61523 
Joseph  R.  O’Donnell 

444  Park,  Glen  Ellyn  60137 
Frank  J.  Jirka,  Jr. 

1507  Keystone  Ave.,  River  Forest  60305 
SAMA  Representatives: 

Joyce  Root 

2801  S.  King  Dr.,  Apt.  912  Chicago  60616 
James  Whitehouse 

15  W.  Delaware  Place,  Chicago  60610 
Staff:  Joseph  Lotharius 

Committee : 

Advisory  to  the  Division  of  Vocational  Rehabilitation 


Responsibilities  and  Purposes: 

The  Council  on  Economics  and  Peer  Review  shall: 

1)  Serve  as  the  appellate  body  for  peer  review  in  the 
state  to  consider  cases  appealed  from  local  committees 
involving  the  quality  and  quantity  of  medical  care; 

2)  Provide  a channel  of  communication  between  ISMS  and 
government  intermediaries,  the  health  insurance  industry. 
Blue  Cross-Blue  Shield  Plans  and  similar  organizations 
in  matters  of  mutual  concern; 

3)  Initiate,  explore  and  bring  to  the  attention  of  the 
Board  of  Trustees  suggested  policies  and  philosophies 
relating  to  medical  service  in  Illinois; 

4)  Advise  the  staff  in  socio-economic  issues  and  further 
the  health  and  welfare  of  the  public  by  seeking  continu- 
ous improvement  of  medical  service  in  Illinois; 

5)  Advise  the  Illinois  Division  of  Vocational  Rehabilita- 
tion and  other  state  health  agencies  on  matters  pertain- 
ing to  fees  and  the  qualitv  of  medical  services 


COUNCIL  ON  EDUCATION  AND  MANPOWER 


Jack  Gibbs,  Chairman 

24-26  Main  Street,  Canton  61520 
Herschel  Browns 

4600  N.  Ravenswood  Ave.,  Chicago  60640 
T.  Howard  Clarke 
999  Lake  Shore  Dr.,  Chicago  60611 
Robert  T.  Fox 

2136  Robin  Crest  Lane,  Glenview  60025 
George  O.  Dohrmann 
3000  Logan  Blvd.,  Chicago  60647 
Lawrence  L.  Hirsch 
834  West  Wellington,  Chicago  60657 
Richard  Magraw 
Box  6998,  Chicago  60680 
Herman  J.  Nebel 

629  Vogel  Place,  East  St.  Louis  62201 
R.  Charles  Oldfield 
40  S.  Clay,  Hinsdale  60521 
James  M.  Schless 

3249  S.  Oak  Park  Ave.,  Berwyn  60402 
Donald  Stehr 

102  E.  Market,  Havana  62644 


Consultants: 

L.  T.  Fruin 

5 Citizen’s  Square,  Normal  61761 
William  M.  Lees 

6518  N.  Nokomis,  Lincolnwood  60646 
Fred  Z.  White 

723  N.  2nd  Street,  Chillicothe  61523 

Medical  School  Representatives: 

Chicago  Medical  School 
James  Shaffer 

2020  W.  Ogden  Ave,  Chicago  60612 
Stritch  School  of  Medicine,  Loyola  University 
AVilliam  B.  Rich 
2160  S.  1st,  Maywood  60153 
Northwestern  University  Medical  School 
Edward  S.  Petersen 
303  E.  Chicago  Ave.,  Chicago  60611 
Rush  Medical  School 
Robert  Carton 

1725  W.  Harrison,  Chicago  60612 
University  of  Chicago 


3r,2 


Illinois  Medical  Journal 


Richard  Landau 

950  E.  59th  Street,  Chicago  60637 
University  of  Illinois 
Richard  Magraw 
Box  6998,  Chicago  60680 
Southern  Illinois  University  School  of  Medicine 
Richard  H.  Moy 

715  E.  Carpenter  St.,  Springfield  62702 
SAMA  Representatives: 

John  Logan 

547  Marengo,  Forest  Park  60130 
Mike  Youssi 

709  South  Ada,  Chicago  60607 
Staff:  Perry  L.  Smithers 

Responsibilities  and  Purposes: 

The  Council  on  Education  and  Manpower  shall  (1) 
study  and  evaluate  all  phases  of  medical  education  in- 
cluding the  development  of  programs  approved  by  the 
House  of  Delegates  for  the  provision  of  a continuing  sup- 
ply of  well-qualified  physicians;  (2)  study  and  evaluate 
education  relating  to  the  health  professions  and  services 
important  to  medicine,  including  the  development  of 


programs  approved  by  the  House  of  Delegates  for  the 
provision  of  a continuing  supply  of  well  qualified  per- 
sonnel in  these  fields;  (3)  carry  to  the  deans  of  the  medi- 
cal schools  recommendations  from  the  viewpoint  of  the 
practicing  physician;  (4)  study,  evaluate  and  criticize  the 
postgraduate  programs  of  ISMS  and  other  organizations; 
(5)  be  available  to  advise  and  cooperate  with  the  Depart- 
ment of  Registration  and  Education  of  the  State  of  Illi- 
nois; (6)  serve  as  liaison  between  ISMS  and  the  Student 
American  Medical  Association;  (7)  administer  the  Student 
Loan  Fund  program  which  is  operated  jointly  by  ISMS 
and  the  Illinois  Agricultural  Association;  and  (8)  organ- 
ize, coordinate  and  administer  the  scientific  sessions  of 
the  ISMS  subject  to  the  regulations  outlined  in  the  By- 
laws, especially  those  in  Chapter  II,  Annual  Convention, 
Section  3,  Scientific  Meetings. 

Committees 

Advisory  to  SAMA 
Allied  Health  Education 
Continuing  Education 
Scientific  Assembly 
Student  Loan  Fund 


COUNCIL  ON  ENVIRONMENTAL  AND  COMMUNITY  HEALTH 


Edward  A.  Piszczek,  Chairman 
6410  N.  Leona,  Chicago  60646 
Howard  C.  Burkhead,  Co-Chairman 
2650  Ridge  Ave.,  Evanston  60201 
Arthur  M.  Barnett 

143  N.  Washington  St.,  Wheaton  60187 
James  P.  Campbell 

322  N.  Blanchard  St.,  Wheaton  60187 
Eugene  F.  Diamond 

11055  S.  St.  Louis  Ave.,  Chicago  60655 
Robert  Hartman 

1515  A West  Walnut  St.,  Jacksonville  62650 
John  S.  Hyde 

603  Forest  Ave.,  Oak  Park  60302 
Ralph  S.  Kunstadter 
664  N.  Michigan,  Chicago  60611 
Arthur  E.  Sulek 

Region  VI,  111.  Dept,  of  Public  Health 
4302  N.  Main  St. 

Rockford  61103 
SAMA  Representatives: 

Alan  Lee  Ansel 

9157  S.  Chappel,  Chicago  60617 
Robert  Pollnow 

2326  W.  48th  St.,  Chicago  60609 
Consultant: 

Warren  W.  Young 

10816  Parnell  Ave.,  Chicago  60628 
Auxiliary  Representative: 

Mrs.  Robert  Hartman 

1040  W.  College,  Jacksonville  62650 
Staff:  Perry  L.  Smithers 


Responsibilities  and  Purposes: 

The  Council  on  Environmental  & Community  Health 
shall  cooperate  with  the  Illinois  Department  of  Public 
Health  in  certain  specific  areas.  Its  responsibilities  shall 
include  the  maintenance,  protection  and  improvement 
of  the  health  of  the  people  of  Illinois  through  organized 
community  efforts. 

It  shall  serve  as  a source  of  information  on  chronic 
illness  and  communicable  diseases  and  cooperate  with  in- 
stitutions and  voluntary  health  agencies  in  disseminating 
such  information. 

It  is  responsible  for  medicine’s  interest  in  the  rela- 
tionship of  man  to  his  surroundings,  particularly  air, 
water  and  soil  pollution;  health  problems  related  to 
population  growth,  urbanization  and  technological  develop- 
ment bearing  on  the  ecology  of  man. 

The  council  also  shall  be  concerned  with  diseases  and 
problems  associated  with  occupational  and  industrial 
health,  cooperate  with  the  Council  on  Occupational 
Health  of  AMA,  Industrial  Medical  Association  and  simi- 
lar state  agencies  and  to  recommend  to  the  State  of  Illi- 
nois Workman’s  Compensation  Board  medical  procedures 
designed  to  assist  the  board  in  the  evaluation  of  claims. 

Committees : 

Public  Safety 
Child  Health 
Maternal  Welfare 
Nutrition 
Radiation  ad  hoc 


36,3 


for  October,  1970 


COUNCIL  ON  LEGISLATION  & PUBLIC  AFFAIRS 


Alfred  J.  Faber,  2100  Swainwood  Drive,  Glenview  60025 
Frank  Holman,  Christian  Welfare  Hospital  1509  Illinois 
Ave.,  East  St.  Louis  62201 

Richard  Allyn,  709  Myers  Building,  Springfield  62701 
John  W.  Ovitz,  Jr.,  204  West  Elm  Street,  Sycamore  60178 
Frank  J.  Kresca,  208  West  Green,  Champaign  61822 
Eugene  J.  Scherba,  13826  Lincoln  Avenue,  Dolton  60419 
James  Ryan,  1309  E.  Court  Street,  Kankakee  60901 
Warren  Tuttle,  203  N.  Vine  Street,  Harrisburg  62946 
John  J.  Ballenger,  723  Elm  St.,  Winnetka 
Consultants: 

C.  J.  Jannings,  HI,  1001  Center  Street,  Fairfield  62837 
Fredric  D.  Lake,  1041  Michigan  Avenue,  Evanston  60202 
Frank  J.  Jirka,  Jr.,  1507  Keystone  Avenue,  River  Forest 
60305 

William  M.  Lees,  6518  Nekomis,  Lincolnwood  60646 
James  B.  Hartney,  410  Lake  Street,  Oak  Park  60302 
Auxiliary  Representative: 

Mrs.  Alan  Taylor,  1607  N.  Vermillion,  Danville  61832 
SAMA  Representative: 

Mark  Brakke.  710  North  Lake  Shore  Dr.,  Chicago  60611 
School  (N.W.  Med  Sch)  6710  North  Sheridan  Road 
Apt.  301,  Chicago  Home 
Staff:  Timothy  D.  Selleck 


Responsibilities  and  Purposes 

The  Council  on  Legislation  and  Public  Affairs  shall: 

1.  Keep  the  Society  and  its  members  aware  of  all  state 
and  federal  legislation  and  laws  affecting  the  health  of 
citizens  of  Illinois  and  the  practice  of  medicine  in 
Illinois. 

2.  Promulgate  legislation  to  improve  the  health  care  of 
citizens  of  Illinois  and  the  practice  of  medicine  in 
Illinois. 

3.  Cooperate  with  the  AMA  in  similar  programs. 

4.  Develop  programs  to  educate  the  public  and  the  Illinois 
State  Medical  Society  membership  in  the  privileges  and 
responsibilities  of  citizenship. 

Committees : 

Public  Affairs 
Eye  Health 

Ear,  Nose  & Throat  Health  Committee 


MEDICAL-LEGAL  COUNCIL 


Clinton  L.  Compere,  Chairman,  737  North  Michigan  Ave- 
nue, Chicago  6061 1 

Ross  Hutchison,  126  East  Ninth,  Gibson  City  60936 
George  Alvary,  1110  North  Green  St.,  McHenry  60050 
David  T.  Petty,  30  North  Michigan  Blvd.,  Chicago  60602 
Vincent  Sarley,  811  W.  Wellington,  Chicago  60657 
Herman  Wing,  400  East  Randolph  St.,  Chicago  60601 
Joseph  Sherrick,  1128  Jeffrey  Court,  West,  Northbrook 
Leonard  C.  Arnold,  1700  W.  Lawrence  Avenue,  Chicago 
60640 

Consultants: 

Wm:  A.  McNichols,  Jr.,  101  West  1st,  Dixon  61021 
Fredric  Lake,  2520  North  Lakeview  Avenue  60614 
William  Lees,  6518  N.  Nokomis,  Lincolnwood  60646 
Joseph  L.  Bordenave,  1665  South  St.,  Geneva  60134 
SAMA  Representatives: 

Gregory  Keller,  825  South  Lathrop,  Forest  Park 
Edward  Quebbeman,  1926  W.  Harrison,  Chicago 
Staff:  H.  Michael  Wild 


Responsibilities  and  Purposes 

The  functions  of  the  Medical  Legal  Council  are  to  1) 
maintain  liaison  with  the  Bar  Association;  2)  supervise 
the  activities  of  the  Council’s  three  committees;  and  3) 
to  educate  the  members  of  the  profession  in  medico-legal 
affairs. 

The  Council  members  include  the  Chairmen  of  the 
Licensure,  IMT,  and  Laboratory  Services  Committees,  to 
facilitate  cooperation  and  coordination  of  activities.  The 
Council  further  cooperates  fully  with  the  AMA  for  pur- 
poses of  coordinating  programming. 

Committees: 

Impartial  Medical  Testimony 

Laboratory  Services 

Licensure 


COUNCIL  ON  MENTAL  HEALTH  AND  ADDICTION 


Marshall  A.  Falk,  Chairman 

4700  N.  Clarendon,  Chicago  60640 
John  H.  McMahan,  Vice-Chairman 
8601  W.  Main  St.,  Belleville  62223 
Nathaniel  S.  Apter 

111  N.  Wabash,  Chicago  60602 
Milton  C.  Baumann 
725  S.  2nd  St.,  Springfield  62704 
Mark  Fields 

716  S.  Milwaukee,  Libertyville  60648 
Irving  Frank 

135  S.  Sacramento,  Sycamore  60178 
Abraham  Gelperin 

835  S.  Wolcott,  Chicago  60612 
Richard  Graff 

204  Julie  Drive,  Kankakee  60901 
Walter  P.  Plassman 

Box  552,  Centralia  62801 


Billie  H.  Shevick 
729-3rd  Ave.,  Moline  61265 
Joseph  H.  Skom 

707  N.  Fairbanks  Ct.,  Chicago  60611 
Alex  Spadoni 

2112  W.  Jefferson,  Joliet  60435 
W.  David  Steed 

1011  Lake  St.,  Oak  Park  60301 
Donovan  Wright 

135  S.  Kenilworth  Ave.,  Elmhurst  60126 
S.AMA  Representatives: 

Richard  Jacobs 

1720  N.  Hudson,  Chicago  60614 
David  Shapiro 

633  S.  Laflin,  Chicago  60607 
Consultant: 

A.  E.  Livingston 

219  N.  Main  St.,  Bloomington  61701 


364 


Illinois  Medical  Journal 


Auxiliary  Representative: 

Mrs.  Michael  Parenti 

1039  Lathrop  Ave.,  River  Forest  60305 
Staff:  Perry  L.  Smithers 

Responsibilities  and  Purposes: 

The  responsibilities  of  this  council  are  as  follows:  It 
shall  serve  as  a source  of  information  on  mental  health 
matters  for  the  ISMS.  It  shall  evaluate  available  informa- 
tion and  make  recommendations  to  the  Board  of  Trus- 
tees for  the  position  the  ISMS  should  take  on  issues  in 
this  area.  It  shall  also  cooperate  with  institutions  and 


voluntary  health  agencies  in  disseminating  information  on 
mental  health  subjects  to  the  profession  and  the  public. 
It  shall  be  on  the  alert  for  misleading  or  fallacious  pro- 
grams and  information  which  need  correcting  for  the 
protection  of  the  public. 

The  Council  shall  be  especially  concerned  with  the 
problems  of  alcoholism  and  drug  abuse. 

Committees : 

Alcoholism 

Narcotics 


COUNCIL  ON  PUBLIC  RELATIONS  AND  MEMBERSHIP  SERVICES 


Matthew  B.  Eisele,  Chairman 

Kil  Mar  Medical  Building,  Suite  209 
8601  W.  Main  St.,  Belleville  62223 
Lee  F.  Winkler 
850  S.  4th,  Springfield  62703 
M.  Douglas  Hursh 

1492  N.  Main  St.,  Wheaton  60187 
Anna  Marcus 

5852  W.  North  Ave.,  Chicago  60639 
Clifton  Reeder 

734  N.  Merrill  Ave.,  Park  Ridge  60068 
Charles  J.  Weigel 
7579  Lake  St.,  River  Forest  60305 
Consultants 
Paul  W.  Sunderland 

214  N.  Sangamon  St.,  Gibson  City  60936 
L.  T.  Fruin 

5 Citizen’s  Square,  Normal  61761 
Fredric  D.  Lake 

1041  Michigan  Ave.,  Evanston  60202 
SAMA  Representatives: 

Henry  Covelli 

414  N.  Taylor,  Apt.  3H,  Oak  Park  60302 


Roger  Rodgers 

5540  Winthrop,  Apt.  #3,  Chicago  60640 
Auxiliary  Representative: 

Mrs.  Leslie  Lindeen 

801  Stevens  Ave.,  Sycamore  60178 
Staff:  Jim  Slawny 

Responsibilities  and  Purposes: 

The  Council  on  Public  Relations  and  Membership 
Services  shall  plan  and  execute  programs  designed  to  en- 
hance the  relationship  between  the  media,  clergy,  gen- 
ral  public  and  medical  profession.  Included  shall  be  health 
education  and  socio-economic  programs  believed  to  be 
in  the  best  interest  of  the  profession  as  well  as  the 
general  public.  The  Council  shall  be  responsible  for  all 
insurance  programs  sponsored  by  ISMS  on  behalf  of  the 
membership.  It  shall  also  be  responsible  for  all  other 
membership  services. 

Committees: 

Medicine  & Religion 
Insurance 


COUNCIL  ON  SOCIAL  & MEDICAL  SERVICES 


Thomas  R.  Harwood,  Chairman 
333  E.  Huron,  Chicago  60611 
William  A.  Hutchison 
4753  N.  Broadway,  Chicago  60640 
Kenneth  A.  Hurst 

157  S.  Lincoln,  Aurora  60505 
Joel  D.  Rosen 

3950  N.  Lake  Shore  Drive,  Chicago  60613 
Paul  Theobald 

1210  Towanda  Plaza,  Bloomington  61801 
Thomas  T.  Tourlentes 

1801  N.  Seminary  St.,  Galesburg  61401 
Consultant: 

L.  T.  Fruin 

5 Citizen’s  Square,  Normal  61761 
SAMA  Representatives: 

Ned  Bartlet 

423  W.  Belden,  Chicago  60657 
Staff:  Robert  Westerbeck 


Responsibilities  and  Purposes: 

The  Council  on  Social  and  Medical  Services  shall  ini- 
tiate and  implement  programs  on  health  and  socio-eco- 
nomic problems  of  the  aging  and  shall  maintain  liaison 
with  other  health  professionals  and  health-oriented  groups 
related  to  the  fields  of  aging,  nursing,  hospital  services, 
rehabilitation  services  and  government  health  care  pro- 
grams. Special  attention  should  be  given  to  quality  of 
care  given  by  health  care  facilities  such  as  hospitals,  nurs- 
ing homes  and  extended  care  facilities. 

Committees : 

Aging 

Nursing 

Rehabilitation  Services 
Hospital  Relations  ad  hoc 


for  October,  1970 


365 


.Committees 

r.t 

The  following  committees  have  been  appointed  for  the  year  1970-1971.  Each  committee  is  assigned  to  a council  for 
reporting  purposes,  except  those  that  are  composed  entirely  of  trustees,  or  which,  for  reasons  of  efficiency  and  control, 
report  directly  to  the  Board  of  Trustees. 


COMMITTEE  ON  AGING 


(Council  on 

Thomas  T.  Tourlentes,  Chairman 

1801  N.  Seminary  St.,  Galesburg  61401 
W.  W.  Bowers 

1820  Delmar  Avenue,  Granite  City  62040 
James  R.  Durham 


Social  & Medical  Services) 

Consultant: 

A.  E.  Livingston 

219  N.  Main,  Bloomington  61701 
Auxiliary  Representative: 

Mrs.  Maurice  Woll 

159  S.  9th,  East  Alton  62024 
Staff:  Robert  Westerbeck 


601 -5th  Ave.,  Mendota  61342 
Bertram  Moss 
Chicago  Medical  School 
1648  S.  Albany,  Chicago  60623 
Clyde  Rtilison 
Box  38,  Roberts  60932 


Responsibilities  and  Purposes: 

The  Committee  on  Aging  shall  consider  matters  related 
to  the  broad  field  of  aging,  including  socio-economic  as 
well  as  medical  services.  The  committee  shall  maintain 
liaison  with  other  agencies  having  a similar  interest,  in- 
cluding the  American  Medical  Association's  Committee 
on  Aging. 


COMMITTEE  ON  ALCOHOLISM 


(Council  on  Mental  Health  and  Addiction) 


Abraham  Gelperin,  Chairman 

835  South  Wolcott,  Chicago  60612 
Charles  L.  Anderson 

120  N.  Oak  Street,  Hinsdale  60521 
David  Stinson 

2126  Jonquil  Place,  Rockford  61103 
J.  M.  Stoker 

172  Schiller  St.,  Elmhurst  60126 
John  C.  Troxel 

222  N.  Dearborn,  Chicago  60601 
William  H.  Wehrmacher 

670  N.  Michigan  Ave.,  Chicago  60611 
James  West 

2400  W.  95th  St.,  Chicago  60642 


SAMA  Representative: 

Mark  Larsen 

710  N.  Lake  Shore  Drive,  Chicago  60611 
Staef:  Perry  L.  Smithers 

Responsibilities  and  Purposes 

The  Committee  on  Alcoholism  serves  as  an  ISMS  re- 
source on  alcoholism  and  evaluates  information  and  makes 
recommendations  to  the  Board  of  Trustees  for  the  posi- 
tion ISMS  should  take  on  issues  in  this  area.  It  cooperates 
with  institutions,  industry,  government  and  health  agen- 
cies in  disseminating  information  on  the  causes,  preven- 
tion, diagnosis,  and  treatment  of  alcoholism  to  the  medi- 
cal profession  and  the  public. 


COMMITTEE  ON  ALLIED  HEALTH  EDUCATION 
(Council  on  Education  and  Manpower) 


Richard  ,M.  Magraw,  Chairman 
Box  6998,  Chicago  60680 
T,awrence  L.  Hirsch,  Vice-Chairman 
834  West  Wellington,  Chicago  60657 
James  D.  Eggers,  Jr. 

,2160  1st  Ave.,  Maywood  60153 
Burton  M.  Krimmer 
5736  W.  North  Ave..  Chicago  60639 
Robert  B.  Lynn 
209  Henry  St.,  Alton  62002 
Donald  E.  Rager 

530  N.  E.  Glen  Oak  Ave.,  Peoria  61603 
Paul  G.  Theobald 

1210  Towanda  Plaza,  Bloomington  61701 
Sheldon  S.  Waldstein 
801  Skokie  Blvd.,  Northbrook  60062 


SAMA  Representative: 

Kevin  Paulsen 

818  S.  Wolcott,  Chicago  60612 
Consultants: 

Walter  C.  Bornemeier 

4655  Peterson  Ave.,  Chicago  60646 
Donald  C.  Frey 

410  N.  Michigan,  Chicago  60611 
James  B.  Hartney 

410  Lake  St..  Oak  Park  60302 
Eugene  P.  Johnson 

22  W.  Main  St.,  Casey  62420 
Israel  Light 

2020  W.  Ogden,  Chicago  60612 
Staff:  Perry  L.  Smithers 


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Illinois  Medical  Journal 


Responsibilities  and  Purposes 

As  a means  to  alleviate  the  effects  of  a physician  short- 
age that  exists  in  virtually  all  parts  of  Illinois,  it  has 
been  suggested  that  allied  health  personnel  be  educated 
and  trained  to  perform  certain  medical  procedures  here- 
tofor  done  only  by  physicians.  This  committee  should  be 
concerned  with  the  specific  types  of  medical  procedures 
which  could  be  done  readily  by  trained  non-physicians 
and  what  education  and  training  is  needed  to  qualify 


such  individuals  as  “assistant  physicians.’’  The  commit- 
tee necessarily  will  concern  itself  with  the  legality  of  this 
activity  under  the  Illinois  Medical  Practice  Act,  the  im- 
plications of  licensure  and  relations  with  the  Illinois 
Department  of  Registration  and  Education,  and  liaison 
with  medical  schools  and  other  educational  institutions 
established  for  training  of  the  personnel  involved. 


COMMITTEE  ON  BENEVOLENCE 
Sub-Committee  of  Finance  Committee 
(Board  of  Trustees) 


Keith  H.  Frankhauser,  Chairman 
Avon  61415 

Allison  L.  Burdick,  Sr. 

5906  West  North  Avenue,  Chicago  60639 
Leo  P.  A.  Sweeney 

10400  South  Western  Avenue,  Chicago  60643 
Auxiliary  Representative: 

Mrs.  Lloyd  Teter 

335  Country  Club  Drive,  Pekin  61554 
Staff:  Frances  C.  Zimmer 

Responsibilities  and  Purposes: 

The  Medical  Benevolence  Committee  shall  be  a sub- 


committee of  the  Finance  Committee  and  shall: 

1)  Examine  applications  to  the  Society  for  assistance  to 
determine  eligibility  for  assistance. 

2)  Keep  the  names  of  the  beneficiaries  confidential  and 
known  only  to  the  committee. 

3)  Recommended  to  the  Finance  Committee  the  allotment 
for  each  recipient,  and 

4)  If  funds  available  become  inadequate  to  meet  disburse- 
ments, request  the  Board  of  Trustees  to  appropriate  suf- 
ficient funds  to  support  the  program  until  the  next  bud- 
get appropriation. 


COMMITTEE  ON  CHILD  HEALTH 
(Council  on  Environmental  and  Community  Health) 


Ralph  H.  Kunstadter,  Chairman 

664  N.  Michigan  Ave.,  Chicago  60611 
Irving  Abrams 

2800  Lake  Shore  Dr.,  Chicago  60657 
Samuel  Adler 

913  Ottawa  Dr.,  Dixon  61021 
Richard  E.  Dukes 
Carle  Clinic,  Urbana  61801 
W.  W.  Fullerton 

101  N.  Market  St.,  Sparta  62286 
Edmond  R.  Hess 

1737  W.  Howard  St.,  Chicago  60626 
Eduard  Jung 

13826  Lincoln  Ave.,  Dolton  60419 
Franklin  Munsey 

1429  Myott  Ave.,  Rockford  61101 
Kenneth  S.  Nolan 

172  Schiller,  Elmhurst  60216 
T.  A.  Palus 

101  Orchard  Terrace,  Lombard  60148 
Norman  T.  Welford 
656-58th  St.,  Hinsdale  60521 
SAMA  Representative: 

Patricia  Dix 

2910  Logan  Blvd.,  Chicago  60647 
Consultants: 

Edward  Lis 

840  S.  Wood,  Chicago  60612 


J.  Keller  Mack 

922  S.  4th  St.,  Springfield  62702 
Auxiliary  Representative: 

Mrs.  Alton  Morris 

1616  Leland  Ave.,  Springfield  62704 
Staff:  Perry  L.  Smithers 

Responsibilities  and  Purposes 

The  committee  shall  serve  as  a source  of  information 
on  matters  pertaining  to  child  health.  It  shall  evaluate 
available  information  and  make  recommendations  to  the 
Board  of  Trustees  for  the  position  the  ISMS  should  take 
on  issues  in  this  area  and  cooperate  with  institutions  and 
voluntary  health  agencies  in  disseminating  information 
pertinent  to  general  child  health.  It  shall  be  on  the  alert 
for  misleading  or  fallacious  programs  and  information 
which  need  correction  for  the  protection  of  the  public. 
It  shall  conduct  educational  programs  for  public  enlight- 
enment for  the  encouragement  and  the  establishment  of 
school  health  councils;  it  shall  strive  for  increased  services 
for  exceptional  children.  It  shall  conduct  in  cooperation 
with  the  Maternal  Welfare  Committee  research  on  neo- 
natal mortality  through  the  state;  and  shall  seek  the 
formulation  and  adoption  of  uniform  school  health 
records. 


for  October,  1970 


367 


COMMITTEE  ON  COMMITTEES 
(Board  of  Trustees) 


Warren  W.  Young,  Chairman 

10816  Parnell  Avenue,  Chicago  60628 
William  A.  McNichols,  Jr. 

101  West  1st  Street,  Dixon  61021 
A.  Edward  Livingston 

219  North  Main  Street,  Bloomington  61701 
Staff:  Frances  C.  Zimmer 


Responsibilities  and  Purposes: 

The  Committee  on  Committees  shall  consist  of  three 
members  of  the  Board  appointed  by  the  chairman.  It 
shall  serve  to  review  the  purposes,  activities  and  structure 
of  any  councils  or  committees  at  the  request  of  the  Board. 
The  committee  shall  recommend  such  changes  in  existing 
councils  or  committees  as  required  to  maintain  the  effi- 
cient operation  of  the  affairs  of  the  Society. 

The  activities  and  reports  of  the  Committee  on  Com- 
mittees shall  be  reviewed  by  the  Executive  Committee 
and  approved  by  the  Board  of  Trustees. 


COMMITTEE  ON  CONSTITUTION  & BYLAWS 
(Board  of  Trustees) 


Charles  K.  Wells,  Chairman 

117  North  10th  Street,  Mt.  Vernon  62864 
Fredric  D.  Lake,  Co-Chairman 

1041  Michigan  Avenue,  Evanston  60202 
Arthur  F.  Goodyear 

142  East  Prairie  Street,  Decatur  62523 
Consultant: 

Frank  M.  Pfeifer 
Staff:  Frances  C.  Zimmer 


Responsibilities  and  Purposes: 

The  Committee  on  Constitution  & Bylaws  shall: 

1)  Receive  from  individual  members,  county  societies, 
committees,  the  Board  of  Trustees  and  the  House  of 
Delegates,  all  suggestions  and  proposals  for  modification 
of  the  Constitution  & Bylaws; 

2)  Prepare  for  the  consideration  of  the  House  of  Dele- 
gates, all  changes  in  the  Constitution  & Bylaws;  and 

3)  Maintain  constant  surveillance  of  both  documents  to 
keep  them  current,  effective  and  consistent  with  the  poli- 
cies of  the  House  of  Delegates. 

The  Speaker  of  the  House  of  Delegates  shall  be  an 
ex-officio  member  of  this  committee. 


COMMITTEE  ON  CONTINUING  EDUCATION 
(Council  on  Education  and  Manpower) 


Herschel  L.  Browns,  Chairman 
4600  N.  Ravenswood,  Chicago  60640 
Dean  R.  Bordeaux,  Vice-Chairman 
2421  W.  Rohmann  Ave.,  Peoria  61604 
Kenneth  W.  Anderson 
8501  Cottage  Grove,  Chicago  60619 
James  A.  Felts 

517  Bainbridge  Rd.,  Marion  62959 
Robert  E.  Fitzgerald 
542  Duane,  Glen  Ellyn  60137 
Leo  R.  Green 

1114  Milton  Road,  Alton  62002 
William  F.  Hubble 

38  S.  Shore  Drive,  Decatur  62521 
Mays  C.  Maxwell 

4202  Bond  Street,  East  St.  Louis  62207 
John  C.  Rathe 

1505-7th  St.,  Moline  61265 
Forrest  H.  Riordan,  III 
5670  E.  State  St.,  Rockford  61108 
Robert  J.  Shafer 

404  W.  Washington,  Petersburg  62675 
Herbert  Sohn 

4640  N,  Marine,  Chicago  60640 
Gordon  H.  Sprague 
502  Shaw  Ave.,  Paris  61944 
SAMA  Representative: 

Kong  Meng  Tan 

1926  W.  Harrison,  Chicago  60612 

CONSUI.TANTS: 

George  Shropshear 

1525  E.  53rd  St.,  Chicago  60615 
Fred  Z.  White 

723  N.  2nd  St.,  Chillicothe  61523 
Staff:  Perry  L.  Smithers 


Responsibilities  and  Purposes 

The  committee  is  responsible  for  encouraging  physi- 
cians of  Illinois  to  keep  abreast  of  medical  advances  by 
participating  in  various  types  of  continuing  education 
programs.  It  should  be  aware  of  the  agencies  offering  con- 
tinuing education  courses,  measure  the  value  of  such 
courses  where  possible  and  strive  to  coordinate  them  in 
order  to  prevent  duplication  and  uncover  significant  gaps 
in  tvpes  of  courses  available. 

The  committee  should  consider  itself  a monitoring  arm 
of  ISMS  rather  than  an  operational  arm,  except  that 
where  specific  areas  of  continuing  education  are  not  avail- 
able to  Illinois  physicians,  it  should  take  whatever  steps 
are  necessary  to  provide  necessary  programs. 

The  prime  responsibility  of  the  committee  is  to  main- 
tain the  excellence  of  the  profession  by  encouraging  ISMS 
members  to  “keep  up”  by  participating  in  acceptable 
continuing  education  programs. 

The  committee  shall  be  responsible  for  operating  a 
Scientific  Speakers  Bureau  through  which  county  medi- 
cal societies  can  obtain  scientific  speakers  for  its  programs. 


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Illinois  Medical  Journal 


SUB-COMMITTEE  ON  DRUGS  AND  THERAPEUTICS 


Robert  C.  Muehrcke,  Chairmaii 
518  N.  Austin  Blvd.,  Oak  Park  60302 
Joseph  D.  Cece 

120  Oakbrook  Center,  Oak  Brook  60521 
Charles  R.  Frazer,  Jr. 

1401  Gaty  Ave.,  East  St.  Louis  62201 
Richard  L.  Landau 
950  E.  59th  St.,  Chicago  60637 
W.  H.  Walton 

109  S.  High  St.,  Belleville  62220 
Consultants: 

Louis  Gdalman,  R.Ph. 

Presbyterian-St.  Luke’s  Hospital 
1753  W.  Congress  St.,  Chicago  60612 
Henry  A.  Holle 

160  N.  LaSalle  St.,  Chicago  60610 
Room  2000 
A.  E.  Livingston 

219  N.  Main  St.,  Bloomington  61701 
Staff:  Mrs.  Pat  Uznanski 


Responsibilities  and  Purposes: 

The  Committee  will  operate  as  a sub  committee  of  the 
-Advisory  Committee  to  the  Illinois  Department  of  Pultlic 
Aid  and  will  continue  to  work  with  the  department  in 
an  effort  to  keep  the  Drug  Manual  current  and  effective. 
When  suggestions  and  comments  from  the  members  are 
submitted  to  the  committee,  it  will  review  them  and 
present  them  to  the  Department  of  Public  Aid  when  ne- 
cessary. The  committee  will  also  consider  other  drug  mat- 
ters affecting  the  policy  of  the  medical  society. 


ETHICAL  RELATIONS  COMMITTEE 
(Board  of  Trustees) 


William  M.  Lees,  Chairman 

6518  North  Nokomis,  Lincolnwood  60646 
James  B.  Hartney 

410  Lake  Street,  Oak  Park  60302 
L.  T.  Eruin 

5 Citizen’s  Square,  Normal  61761 
Ered  Z.  White 

723  N.  Second  Street,  Chillicothe  61523 

Responsibilities  and  Purposes: 

The  responsibilities  and  purposes  of  this  committee 
are  outlined  in  CHAPTER  XI.  DISCIPLINE,  Part  2 
Illinois  State  Medical  Society  Procedure 
Section  1.  Illinois  State  Medical  Society  Ethical  Relations 
Committee.  The  Board  of  Trustees  shall  appoint  from 
its  members  an  Ethical  Relations  Committee  to  review 
decisions  of  the  component  society  involving  the  inter- 
pretation of  the  Principles  of  Medical  Ethics,  violations 
of  the  Constitution  and  By-laws  of  the  Illinois  State 
Medical  Society  or  its  component  societies  and  charges  of 
misconduct  of  members  of  the  Society. 

Section  2.  Appeals  from  Component  Society  Verdicts.  Ap- 
peals received  by  the  Illinois  State  Medical  Society  Board 
of  Trustees  shall  be  referred  to  the  Ethical  Relations 
Committee  of  the  Board  for  review.  (Appeals  must  be  ac- 


comjianied  by  a comprehensive  stenographic  record  of 
the  proceedings  taken  Ijefore  the  component  county  so- 
ciety together  with  all  exhibits  submitted  in  evidence. 
If  the  component  county  society  fails  to  provide  the 
record  on  appeal,  the  Ethical  Relations  Committee  of 
Illinois  State  Medical  Society  shall  find  the  accused  “not 
guilty’’).  The  committee  shall  notify  the  accused  and  the 
secretary  of  the  component  society  by  certified  mail  at 
least  thirty  days  prior  to  the  date  set  for  the  hearing  of 
the  appeal.  The  chairman  of  the  committee  shall  preside 
over  the  hearing  in  accordance  with  the  rules  established 
by  the  Board  of  Trustees. 

Section  3.  Verdict.  The  Ethical  Relations  Committee  of 
the  Board  of  Trustees  shall  hear  any  new  and  pertinent 
evidence  any  interested  party  desires  to  present,  and  at 
the  conclusion  of  the  trial,  the  decision  of  the  component 
society  shall  be  affirmed,  overruled  or  sent  back  to  the 
component  society  for  reconsideration. 

Section  4.  Notification  and  right  of  appeal.  The  secretary 
of  the  Society  shall  notify  the  defendant  and  the  secre- 
tary of  the  component  society  wherein  the  defendant  holds 
membership,  of  the  action  of  the  Board.  In  the  event  of 
a decision  against  the  accused  he  shall  have  the  right  to 
appeal  the  decision  to  the  Judicial  Council  of  the  Ameri- 
can Medical  .Association  and  the  secretary  of  the  State 
Society  shall  so  notify  the  accused  of  this  right. 


Willard  C.  Scrivner,  Chairman 
4601  State  St.,  East  St.  Louis  62205 
Joseph  L.  Bordenave 

1665  South  St.,  Geneva  60134 
Mather  Pfeiffenberger 
State  and  Wall  Sts.,  Alton  62002 
L.  T.  Eruin 

5 Citizen’s  Square,  Normal  61761 
J.  Ernest  Breed 

55  East  Washington  St.,  Chicago  60602 


EXECUTIVE  COMMITTEE 
(Board  of  Trustees) 

Jacob  E.  Reisch 

1129  South  2nd  St.,  Springfield  62704 
Frank  J.  Jirka.  Jr. 

1507  Keystone  Avenue,  River  Forest  60305 
Edward  W.  Cannady 
4601  State  St.,  East  St.  Louis  62205 
Staff:  Roger  N.  White 

Erances  C.  Zimmer 


for  October,  1970 


369 


Responsibilities  and  Purposes: 

The  Executive  Committee  shall  consist  of  the  president, 
the  president-elect,  the  chairman  of  the  Board,  the  chair- 
man of  the  Finance  Committee,  the  chairman  of  the 
Policy  Committee,  the  secretary-treasurer,  the  trustee-at- 
large  and  the  immediate  past  chairman  of  the  Board  pro- 
vided he  is  still  a Trustee. 

It  may  be  given  authority  to  act  by  the  Board  of 
Trustees. 


In  matters  of  routine  administration,  special  plans,  pol- 
icy, endorsement  or  expenditure  it  shall  report  to  and 
request  approval  of  the  Board.  It  shall  receive  the  re- 
ports of  the  Finance  and  Policy  Committees  and  make 
recommendations  concerning  them  to  the  Board.  It  shall 
furnish  a report  of  its  actions  to  the  Board  at  each 
meeting. 

Bylaws.  Chapter  IX,  Part  4,  Section  2.  Paragraph  A. 


EAR  NOSE  & THROAT  HEALTH  COMMITTEE 
(Council  on  Legislation  and  Public  Affairs) 


John  J.  Ballenger,  Chairman,  723  Elm  Street,  Winnetka 
George  H.  Conner,  1725  West  Harrison,  Chicago 
Paul  H.  Holinger,  700  North  Michigan,  Chicago 
Richard  E.  Marcus,  64  Old  Orchard,  Skokie 
William  A.  Weiss,  118  West  Laurel  Street,  Springfield 
Guy  O.  Pfeiffer,  213  South  17th  Street,  Mattoon 
Consultants: 

Meyer  Fox,  2040  West  Wisconsin  Avenue,  Milwaukee 
Earl  Harford.  Northwestern  Medical  School,  303  East 
Chicago  Avenue,  Chicago 

Maurice  Hoeltgen,  1836  West  87th  Street,  Chicago 
Staff:  Larry  N.  Booth 


Responsibilities  and  Purposes 

The  function  of  the  Ear  Nose  and  Throat  Health 
Committee  is  to  concern  itself  with  state  legislation  re- 
garding Laryngological  and  Otological  matters,  to  secure 
and  disseminate  information  and  make  recommendations 
regarding  specific  legislative  proposals.  The  Ear  Nose 
and  Throat  Committee  shall  also  work  in  connection 
with  the  Chicago  Laryngological  and  Otological  Society. 


EYE  HEALTH  COMMITTEE 
(Council  on  Legislation  and  Public  Affairs) 


Frank  J.  Kresca,  Chairman,  208  West  Green,  Champaign 
61820 

David  L.  Brown,  122  S.  Michigan,  Chicago  60603 
Willjur  W.  Baumgartner,  118  N.  Chestnut,  Kewanee  61443 
James  R.  Fitzgerald,  6429  North  Avenue,  Oak  Park  60302 
Max  Hirschfelder,  Box  529,  Centralia  62801 
Edward  Kwedar,  615  S.  7th,  Springfield  62703 
Lawrence  J.  Lawson,  636  Church  St.,  Evanston  60201 
Charles  L.  Pannabecker,  331  Fulton  Street,  Peoria  61602 
Manuel  L.  Stillerman,  111  N.  Wabash,  Chicago  60602 
M.  Byron  Weisbaum,  520  E.  Allen  Street,  Springfield 
62703 

Maurice  M.  Hoeltgen,  1836  West  87th  Street,  Chicago 
60620 

Consultants: 

William  A.  McNichols,  Jr.,  101  West  1st  Street,  Dixon 
61021 

Staff:  H.  Michael  Wild  and  Larry  N.  Booth 


Responsibilities  and  Purposes 

The  function  of  the  Eye  Health  Committee  is  to  con- 
cern itself  with  state  legislation  regarding  ophthalmic  mat- 
ters, to  secure  and  disseminate  information  and  make 
recommendations  regarding  specific  legislative  proposals. 
The  Eye  Committee  also  meets  with  the  Illinois  State 
Joint  Council  of  Ophthalmology  to  study  problems  and 
formulate  policy  on  the  medical  and  social-economic  as- 
pects of  ophthalmology. 


FINANCE  COMMITTEE 
(Board  of  Trustees) 


Mather  Pfeiffenberger,  Chairman 
State  & Wall  Streets,  Alton  62002 
Jacob  E.  Reisch 

1129  South  2nd  Street,  Springfield  62704 
William  M.  Lees 

6518  North  Nokomis,  Lincolnwood  60646 
Fred  Z.  White 

723  North  Second  Street,  Chillicothe  61523 
Staff:  Roger  N.  White 
Sandie  Koelbel 


Responsibilities  and  Purposes: 

The  Finance  Committee  shall  consist  of  the  secretary- 
treasurer  of  the  Society  and  three  members  of  the  Board 
appointed  by  the  chairman.  It  shall  develop  for  approval 
of  the  Board  through  the  Executive  Committee,  a budget 
for  the  fiscal  year.  It  shall  supervise  the  financial  trans- 
actions of  the  Society.  It  shall  make  recommendations  to 
the  Board  for  the  control  and  investment  of  the  funds 
of  the  Illinois  State  Medical  Society. 


370 


Illinois  Medical  Journal 


COMMITTEE  ON  HEALTH  CARE  FINANCING 
(Board  of  Trustees) 


A,"" 


Joseph  R.  O’Donnell,  Chairman 
444  Park,  Glen  Ellyn  60137 
James  B.  Hartney 
410.  Lake  St.,  Oak  Park  60302 
Frank  J.  Jirka,  Jr. 

1507  Keystone  Ave.,  River  Forest  60302 
Frederick  E.  Weiss 

15643  Lincoln,  Harvey  60426 
Eugene  P.  Johnson 
22  W.  Main  St.  Casey  62420 
Joseph  L.  Bordenave 

1665  South  St.,  Geneva  60134 
Consultant: 

Jacob  E.  Reisch 

1129  S.  Second  St.,  Springfield  62704 
Staff;  Joseph  Lotharius 


Responsibilities  and  Purposes: 

The  Committee  on  Health  Care  Financing  shall  con- 
sider new  concepts  of  health  care  delivery  and  submit 
recommendations  to  the  Board  on  the  feasibility  of  im- 
plementing such  concepts  at  the  county,  district  and  or 
state  level.  The  committee  shall  also  define  the  usual, 
customary,  and  reasonable  fee  concept  and  assure  its  ad- 
herence throughout  the  state.  In  performing  this  func- 
tion, the  committee  shall  meet  with  representatives  of 
health  insurance  carriers,  government  intermediaries  and 
other  third  parties.  It  shall  also  review  the  adequacy 
and  appropriateness  of  physician  reimbursement  in  ac- 
cordance with  ISMS  policies. 


AD  HOC  COMMITTEE  ON  HOSPITAL  RELATIONS 
(Council  on  Social  and  Medical  Services) 

Julian  Buser,  Chairman,  4601  State  St.,  East  St.  Louis 
62205 

Standby  ad  hoc  committee;  committee  members  to  be 
appointed  when  needed. 


COMMITTEE  ON  IMPARTIAL  MEDICAL  TESTIMONY 
(Medical-Legal  Council) 


Vincent  Sarley,  Chairman,  811  West  Wellington,  Chicago 
60657 

Dennis  Dorsey,  Box  487,  Winfield  60190 
Jerome  J.  McCullough,  100  North  High  Street,  Belleville 
62220 

Maurice  D.  Murfin,  250  North  Water  St.,  Decatur  62523 
Ronald  Shlensky,  251  East  Chicago,  Chicago 
Consultants; 

Samuel  Levinson,  3730  Lake  Shore  Drive,  Chicago  60613 
Clinton  Compere,  737  North  Michigan,  Chicago  60611 
James  B.  Hartney,  410  Lake  Street,  Oak  Park  60302 
Staff:  H.  Michael  Wild 


Responsibilities  and  Purposes 

The  Committee  shall  cooperate  with  the  judiciary  in 
both  federal  and  state  courts  within  the  state  of  Illinois. 
It  shall,  when  requested  by  the  court,  implement  the  Im- 
partial Medical  Testimony  panel.  The  stated  objective 
of  the  panel  is  to  provide  consultations,  judgment  and 
opinions  in  personal  injury  situations  in  which  there  is 
unusual  controversy  or  wide  divergence  of  medical  opinion. 


COMMITTEE  ON  INSURANCE 
(Council  on  Public  Relations  & Membership  Services) 


Clifton  L.  Reeder,  Chairman 
734  N.  Merrill  Ave.,  Park  Ridge  60068 
Philip  D.  Boren 
507  W.  Main,  Carmi  62821 
A.  Everett  Joslyn 

557  Keystone  Ave.,  River  Forest  60305 
James  B.  Flanagan 

10448  S.  Crawford  Ave.,  Oak  Lawn  60453 
Lawrence  Knox 
600  E.  Main,  Olney  62450 
Consultants: 

A.  Edward  Livingston 

219  N.  Main,  Bloomington  61701 
Jacob  E.  Reisch 

1129  S.  2nd  St.,  Springfield  62704 
Fred  Z.  White 

723  N.  Second  St.,  Chillicothe  61523 
Staff:  Marian  Thiele 


Responsibilities  and  Purposes: 

The  Committee  on  Insurance  will  review  society-spon- 
sored insurance  programs,  which  are  currently  the  Tax 
Qualified  Investment  Program  (Keogh),  Retirement  In- 
vestment Program,  Group  Disability  Program,  Group 
Major  Medical  Program  and  Professional  Liability  In- 
surance Program.  The  committee  will  study  these  plans, 
make  suggestions  for  changes,  additions  and  cancellation 
of  policies,  and  investigate  other  insurance  programs  that 
may  benefit  society  members. 


for  October,  1970 


371 


COMMITTEE  ON  LABORATORY  SERVICES 
(Medical-Legal  Council) 


Joseph  Sherrick,  Chairman,  1128  Jeffrey  Court,  West 
Northbrook 

Ronald  Jessen,  350  North  Wall  Street,  Kankakee  60901 
John  J.  Mueller,  24  Logan  Fairmont  Addition,  Alton  62002 
Peter  Soto,  211  S.  Third  Street,  Belleville  62221 
Hans  Willuhn,  1335  Charles  Street,  Rockford  61108 
Jack  Williams,  130  E.  Randolph,  Chicago  60601 
Consultant: 

James  B.  Hartney,  410  Lake  Street,  Oak  Park  60302 
Staff:  H.  Michael  Wild 


Responsibilities  and  Purposes 

The  committee  shall  effect  methods  of  elevating  and 
maintaining  the  standards  of  medical  laboratories  in  Il- 
linois, encourage  the  use  of  medical  diagnostic  labora- 
tories supervised  by  duly  qualified  physicians,  and  en- 
courage each  county  and  district  to  establish  evaluation 
committees. 


COMMITTEE  ON  LICENSURE 
(Medical-Legcil  Council) 


Ross  Hutchison,  Chairman,  126  East  9th  Street,  Gibson 
City  60936 

Wilson  West,  7300  State,  East  St.  Louis  62203 
Clay  Jones,  3233  South  Park  Avenue,  Chicago  60616 
Henry  Boldt,  3526  N.  California,  Peoria,  Illinois 
Raymond  B.  Murphy,  R.  3,  Box  19,  Robinson  62454 
Morgan  Meyer,  815  South  Main,  Lombard  60148 
William  T.  Davin,  9701  West  Grand  Avenue,  Franklin 
Park 

Earl  Klaren,  158  E.  Cook  Street,  Libertyville  60048 
Consultants: 

Charles  K.  Wells,  117  N.  10th  St.,  Mt.  Vernon  62864 
Joseph  L.  Bordenave,  1665  South  St.,  Geneva  60134 
Frank  J.  Jirka,  Jr.,  1507  Keystone,  River  Forest  60305 
Staff:  H.  Michael  Wild 


Responsibilities  and  Purposes 
The  committee  shall  concern  itself  with  the  illegal  prac- 
tice of  medicine  and  other  healing  arts  groups  associated 
with  unfounded  claims  for  cure  of  disease.  It  shall  co- 
operate with  the  legal  authorities  of  the  state,  such  as 
the  office  of  the  Attorney  General  and  the  Department  of 
Registration  and  Education  and  concern  itself  with  the 
general  problems  of  licensure.  It  shall  cooperate  with 
the  AMA’s  Department  of  Investigation  and  other  agen- 
cies interested  in  this  field. 


COMMITTEE  ON  MATERNAL  WELFARE 
(Council  on  Environmental  and  Community  Health) 


Robert  R.  Hartman,  Chairman 

1515A  Walnut  St.,  Jacksonville  62650 
Frederick  H.  Falls,  Chairman  Emeritus  & 

Special  Consultant 
Box  47,  River  Forest  60305 

District  Members  and  Alternates 

(alternates  in  italics) 

1.  William  R.  Larsen 

13707  W.  Jackson,  Woodstock  60098 
Gordon  T.  Burns 
2300  N.  Rockton,  Rockford  61101 

2.  William  J.  Farley 

710  Peoria  St.,  Peru  61354 
Donald  M.  Gallagher 
Box  538,  Granville  61326 

3.  Melvin  Goodman 

13826  Lincoln  Ave.,  Dolton  60419 
Charles  F.  Kramer 

12647  Justine  St.,  Calumet  Park  60643 

4.  V.  B.  Adams 

301  E.  Jefferson,  Macomb  61455 
Ralph  Gibson 

416  St.  Marks  Ct.,  #410,  Peoria  61603 

5.  William  W.  Curtis 

100  W.  Miller  St.,  Springfield  62702 
Robert  Maletich 

1025  S.  7th  St.,  Springfield  62703 


6.  Robert  R.  Hartman 

1515A  Walnut  St.,  Jacksonville  62650 
Richard  Yoder 

601  E.  3rd,  Alton  62002 

7.  Paul  A.  Raber 

149  W.  King  St.,  Decatur  62521 
Hubert  Magill 

1170  E.  Riverside,  Decatur  62521 

8.  John  C.  Mason  Jr. 

715  N.  Logan  Ave.,  Danville  61832 
John  R.  Powell 

602  W.  University  Ave.,  Urbana  61801 

9.  Harry  J.  Lewis 

104  S.  Maple,  Benton  62812 
Donald  R.  Risley 
319  Market  St.,  Mt.  Carmel  62863 

10.  James  B.  Stotlar 

15  N.  Walnut,  Pinckneyville  62274 
William  R.  Malony 
Box  1030,  Carbondale  62901 

11.  John  J.  McLaughlin 

2100  Glenwood,  Joliet  60435 
Charles  P.  Westfall 
172  Schiller  St.,  Elmhurst  60126 


372 


Illinois  Medical  Journal 


Consultants: 

John  Louis 

10721  S.  Hoyne,  Chicago  60643 
Willard  C.  Scrivner 

4601  State  St.,  East  St.  Louis  62205 
Augusta  Webster 

707  N.  Fairbanks  Ct.,  Chicago  60611 
Franklin  D.  Yoder 

535  W.  Jefferson  St.,  Springfield  62707 
Staff:  Perry  L.  Smithers 


Responsibilities  and  Purposes 

The  committee  shall  cooperate  with  the  State  Depart- 
ment of  Public  Health  in  reducing  the  maternal  mor- 
tality rate  in  Illinois.  As  a means  of  achieving  this  goal, 
it  shall  review  all  maternal  deaths  reported  and  send 
its  evaluation  of  the  management  of  the  case  to  the  at- 
tending physician.  Appropriate  measures  should  be  taken 
to  share  the  results  of  this  research  with  those  practi- 
tioners in  a position  to  apply  it  for  the  benefit  of  their 
patients. 


COMMITTEE  ON  MEDICINE  & RELIGION 


(Council  on  Public  Relations 

Anna  A.  Marcus,  Chairman 
5852  W.  North.  Chicago  60639 
William  B.  Rich 

1400  S.  1st  Ave.,  Hines  60141 
Clement  P.  Cunningham 
2526  18th  Ave.,  Rock  Island  61201 
Charles  W.  Pfister 

5511  N.  Harlem  Ave.,  Chicago  60656 
William  H.  Whiting 
Box  410,  525  N.  Main,  Anna  62906 
David  J.  Kweder 

4 S.  Genesee  St.,  Waukegan  60085 
Consultants: 

Rev.  Herman  Cook 

Chaplains  Office,  University  of  Chicago  Hospitals 
950  E.  59th  St.,  Chicago  60637 
Rabbi  Mordecai  Simon 

Chicago  Board  of  Rabbis,  Suite  500 
72  E.  11th  Street,  Chicago  60605 


and  Membership  Services) 

Father  John  Marren 

Holy  Trinity  Church,  916  S.  Wolcott  Chicago  60612 
Warren  Young 

10816  Parnell  Ave.,  Chicago  60628 
Auxiliary  Representative: 

Mrs.  Sherman  C.  Arnold 

2416  Brookwood  Ave.,  Flossmoor  60422 
SAMA  Representative: 

Nancy  Stoit 

902  S.  Dunlop,  Forest  Park  60130 
Staff:  Marian  Thiele 

Responsibilities  and  Purposes: 

The  primary  purpose  of  the  Committee  on  Medicine 
and  Religion  is  to  assist  in  establishing  similar  commit- 
tees on  the  county  level.  It  is  also  responsible  for  creat- 
ing closer  ties  between  physicians  and  the  clergy,  leading 
to  total  patient  care. 


COMMITTEE  ON  NARCOTICS 
(Council  on  Mental  Health  and  Addiction) 


Joseph  H.  Skom,  Chairman 

707  N.  Fairbanks  Court,  Chicago  60611 
Richard  B.  Eisenstein 

111  N.  Wabash,  Chicago  60602 
Jerome  H.  Jaffe 
950  E.  59th  St.,  Chicago  60637 
Kermit  T.  Mehlinger 
3312  W.  Grenshaw,  Chicago  60614 
Harry  W.  Parks 

Memorial  Hospital,  N.  Park  Drive,  Belleville  62223 
George  Silvest 

114  E.  Everett,  Dixon  61021 
David  Slight 

25  E.  Washington  St.,  Chicago  60602 
SAMA  Representative: 

Robert  Strauss 

61  E.  Goethe  St.,  Chicago  60610 


Consultant: 

Wm.  A.  McNichols,  Jr. 

101  W.  1st  St.,  Dixon  61021 
Staff:  Perry  L.  Smithers 

Responsibilities  and  Purposes 

The  functions  of  the  Committee  are:  (1)  study,  research 
and  dissemination  of  educational  information  on  nar- 
cotics and  hazardous  substances  to  members  of  the  medi- 
cal profession;  (2)  to  recommend  acceptable  measures  for 
the  control  of  distribution,  the  use  and  disposal  of  nar- 
cotics and  hazardous  substances,  exclusive  of  radiation 
products  but  including  poison  control,  and  (3)  to  co- 
operate with  official  and  non-official  agencies  in  all  mat- 
ters pertaining  to  this  subject. 


for  October,  1970 


373 


COMMITTEE  ON  NURSING 
(Council  on  Social  and  Medical  Services) 


William  A.  Hutchison,  Chairman 
4753  N.  Broadway,  Chicago  60640 
David  M.  Greeley 

1130  Michigan  Ave.,  Evanston  60202 
Jaroslav  F.  Neskodny 

6820  Windsor  Ave.,  Berwyn  60402 
H.  J.  Kolb 

303  Sherman,  St.  Joseph  61873 
Roger  Sondag 

535  W.  Jefferson  St.,  Springfield  62706 
Consultants: 

Mrs.  Helen  Grace 

University  of  Illinois,  P.O.  Box  6998 
Chicago  60680 
Mrs.  Joyce  Taylor 

363  E.  Burlington,  Riverside  60546 


AuxiLiARY  Representative: 

Mrs.  Thomas  Clatter 

2407  Spring  Brook  Ave.,  Rockford  61107 
Staff:  Marian  Thiele 

Responsibilities  and  Purposes: 

The  primary  purpose  of  the  Committee  on  Nursing 
is  to  establish  a close  professional  relationship  between 
physicians  and  nurses  and  to  assist  in  recruiting  programs 
to  help  relieve  the  current  nursing  shortage.  The  com- 
mittee will  also  work  to  improve  educational  programs 
for  nurses,  working  relationships  between  physicians  and 
nurses  in  hospitals,  and  the  nurses’  hospital  duties,  to 
utilize  their  full  potential  and  skill. 


COMMITTEE  ON  NUTRITION 


(Council  on  Environmental 

Eugene  F.  Diamond,  Chairman 
11055  S.  St.  Louis,  Chicago  60655 
Sheldon  Berger 

707  N.  Fairbanks  Ct.,  Chicago  60611 
William  R.  Clarke 

1211  S.  Independence  Blvd.  Chicago  60623 
Allen  A.  Filek 

1806  Maple,  Box  870,  Evanston  60204 
Elliot  G.  Goldin 

5214  N.  Western  Avenue,  Chicago  60625 
Ben  A.  Kinsman 

20  N.  Washington,  DuQuoin  62832 
Alfred  D.  Klinger 

5229  Woodlawn  Ave.,  Chicago  60615 
Philip  Lynch 

1314  N.  Main,  Decatur  62526 
Rene  St.  Leger 

3909  State  St.,  East  St.  Louis  62205 
John  E.  Walters 

231  E.  75th  St.,  Chicago  60619 


and  Community  Health) 


Consultants: 

Paul  A.  Dailey 

620  N.  Main  St.,  Carrollton  62016 
George  Shropshear 

1525  E.  53rd  St.,  Chicago  60615 
Staff:  Perry  L.  Smithers 

Responsibilities  and  Purposes 

The  committee  shall  serve  as  a source  of  information  on 
nutrition  matters  for  the  ISMS  and  evaluate  available 
information  and  make  recommendations  to  the  Board  of 
Trustees  for  the  position  the  ISMS  should  take  on  issues 
in  this  area.  It  shall  cooperate  with  institutions  and  volun- 
tary liealth  agencies  in  disseminating  information  on  nu- 
trition subjects  to  the  profession  and  to  the  public.  It 
shall  be  on  the  alert  for  misleading  or  fallacious  programs 
and  information  which  need  correction  for  the  protection 
of  the  public. 


COMMITTEE  TO  STUDY  OSTEOPATHIC  PROBLEMS 


(Board 

Arthur  F.  Goodyear,  Chairman 

142  East  Prairie  Street,  Decatur  62523 
Eugene  P.  Johnson 
22  West  Main  Street,  Casey  62420 
Frederick  E.  Weiss 

15643  Lincoln,  Harvey  60426 
Fredric  D.  Lake 

1041  Michigan  Avenue,  Evanston  60202 
Staff:  Roger  N.  White 

POLICY 

(Board 

Joseph  L.  Bordenave 

1665  South  Street,  Geneva  60134 
James  B.  Hartney 
410  Lake  Street,  Oak  Park  60302 
William  A.  McNichols  Jr. 

101  West  1st  Street,  Dixon  61021 
Staff:  Frances  C.  Zimmer 


of  Trustees) 

Responsibilities  and  Purposes: 

The  responsibilities  of  this  committee  are  to  assist  in 
developing  rapport,  cooperation  with  and  an  understand- 
ing of  the  osteopathic  profession.  The  committee  shall 
study  and  report  on  the  present  situation  in  Illinois  in 
view  of  recent  action  by  the  House  of  Delegates  which 
permits  qualified  osteopaths  to  be  members  of  the  Medi- 
cal Society. 

COMMITTEE 
of  Trustees) 

Responsibilities  and  Purposes: 

The  Policy  Committee  shall  consist  of  three  members 
of  the  Board  appointed  by  the  chairman.  It  shall  con- 
tinually review  past  and  current  proceedings  of  the  House 
of  Delegates  to  determine  the  established  policies  of  the 
Illinois  State  Medical  Society.  It  shall  make  recommen- 
dations for  future  policy  by  Board  resolution  to  the  House 
of  Delegates. 


374 


Illinois  Medical  Journal 


COMMITTEE  ON  PUBLIC  AFFAIRS 
(Council  on  Legislation  and  Public  Affairs) 


John  W.  Ovitz  Jr.,  Chairman,  204  West  Elm,  Sycamore 
60118 

Herbert  Sohn,  Co-Chairman,  4640  N.  Marine  Drive,  Chi- 
cago 60640 

William  Ashley,  6545  West  33rd  Street,  Berwyn  60402 
William  W.  Boswell,  2500  North  Rockton,  Rockford  61103 
Herschel  L.  Browns,  4600  North  Ravenswood  Avenue, 
Chicago 

James  E.  Coeur,  630  Locust  Street  Carthage  62321 
Edwin  L.  Falloon,  9534  S.  Central  Park,  Evergreen  Park 
Justin  Fleischmann,  320  S.  Ela  Road,  Palatine  60067 
George  J.  Gertz,  2376  E.  71st  Street,  Chicago  60649 
J.  R.  Shackelford,  Medical  Center  Clinic  of  Paris,  Paris 
61944 

William  J.  Hillstrom,  280  Virginia  Avenue,  Crystal  Lake 
60014 

James  Heersma,  117  N.  10th  St.,  Mt.  Vernon  62864 
Rocco  Lobraico,  Jr.,  4833  Peterson,  Chicago  60646 
Earl  V.  Klaren,  158  E.  Cook  St.,  Libertyville  60048 
W.  Robert  Malony,  Carbondale  Clinic,  Carbondale  62901 
Charles  Downing,  1067  W.  Main,  Decatur  62522 
James  D.  Rogers,  120  Scott  St.,  Joliet  62401 
Earle  Walker,  203  North  Vine,  Harrisburg  62946 
Stanley  E.  Ruzich,  9944  S.  Damen,  Chicago  60643 
James  H.  Geist,  12  Old  Orchard,  Route  5,  Kankakee 
John  L.  Savage,  723  Elm  St.,  Winnetka  60093 
Julius  P.  Schweitzer,  120  Oakbrook  Mall,  Oak  Brook  60521 
Lee  Winkler,  850  S.  4th,  Springfield  62703 
Eugene  H.  Siegel,  103  Haven  Road,  Elmhurst  60126 
Lorin  D.  Whittaker,  840  Jefferson  Building,  Peoria  61602 

COMMITTEE  ON 
(Council  on  Environmental 

James  P.  Campbell,  Chairman 

322  N.  Blanchard  St.,  Wheaton  60187 
William  Hark 

30  N.  Michigan,  Chicago  60602 
Edward  W.  Holmblad 

1350  N.  Lake  Shore  Dr.,  Chicago  60610 
Max  Klinghoffer 

127  E.  Vallette  St.,  Elmhurst  60126 
Julius  Kowalski 

436  Park  Ave.,  E.,  Princeton  61356 
Norman  J.  Rose 

535  W.  Jefferson  St.,  Springfield  62607 
William  J.  Schnute 

737  N.  Michigan,  Chicago  60611 
Clifford  P.  Sullivan 
2800  W.  87th  St.,  Chicago  60652 


Consultants: 

Theodore  Grevas,  1800  Third  .4venue,  Rock  Island 
61201 

L.  T.  Fruin,  5 Citizen’s  Square,  Normal  61761 
Frederick  E.  Weiss,  15318  Center  Avenue,  Harvey  60426 
Auxiliary  Representatives: 

Mrs.  H.  J.  Failor,  9 Litchfield  Lane,  Champaign  61120 
Mrs.  Harry  Parks,  25  High  Forest,  Belleville  62221 
SAMA  Representative: 

Steven  Lipnik,  416  West  5th  Street,  Momence,  111.  60954, 
815/472-2529 

Staff:  Timothy  D.  Selleck 

Responsibilities  and  Purposes 

The  Public  Affairs  Committee  is  concerned  with  the 
political  process  as  it  pertains  to  medicine  and  public 
health.  Within  this  broad  context,  appropriate  education 
of  the  public  is  basic  to  continued  health  improvement 
in  a free  society.  The  electorate  must  make  its  wishes 
known  to  public  officials. 

The  Public  Affairs  Committee  shall  strive  to  generate 
interest  in  the  overall  field  of  politics  to  enable  the 
physician  to  participate  effectively.  Programs  of  public 
affairs  orientation,  political  education  and  campaign 
characteristics  will  be  undertaken  to  increase  the  effec- 
tiveness of  the  physician  in  public  affairs. 

PUBLIC  SAFETY 
and  Community  Health) 

S.4MA  Representative: 

Robert  Luther 

833  W.  Buena,  Chicago  60613 
Auxiliary  Representative: 

Mrs.  Arthur  Smith 

206  Country  Club  Lane,  Belleville  62223 
Staff:  Perry  L.  Smithers 

Responsibilities  and  Purposes 

The  Committee  shall  study  the  medical  aspects  of  acci- 
dent prevention;  alert  the  public  to  seasonal  health  haz- 
ards; and  co-operate  with  the  Illinois  Department  of  Pub- 
lic Health,  the  National  Safety  Council  and  similar  or- 
ganizations. 


PUBLICATIONS  COMMITTEE 


(Board  of  Trustees 

Jacob  E.  Reisch,  Chairman 

1129  South  Second  Street  Springfield  62704 
A.  Edward  Livingston 

219  North  Main  Street,  Bloomington  61701 
Warren  W.  Young 

10816  Parnell  Avenue,  Chicago  60628 
Staff:  Richard  A.  Ott 

Responsibilities  and  Purposes: 

The  Publications  Committee  shall  be  composed  of  mem- 
bers of  the  Board  of  Trustees,  and  shall  be  responsible 
for  the  production  of  the  Illinois  Medical  Journal  and 
other  Society  publications. 


Board  Committee) 


It  shall  recommend  to  the  Board  of  Trustees  all  poli- 
cies governing  the  editorial,  business  and  production  as- 
pects of  the  Journal.  It  shall  supervise  the  editor  in  the 
selection  and  preparation  of  all  copy,  and  it  shall  estab- 
lish standards  for  the  editorial  content. 

It  shall  establish  advertising  policies,  rates,  and  stand- 
ards, and  shall  review  all  new  accounts  prior  to  acceptance, 
and  shall  approve  reprint  and  circulation  policies. 

It  shall  conduct  a periodic  review  of  the  printer’s  con- 
tract and  solicit  bids  as  indicated.  It  shall  establish  the 
format,  cover,  type  faces  and  general  layout  of  the  Journal. 


for  October,  1970 


375 


EDITORIAL  BOARD 

(Sub-Committee  of  Publications  Committee) 


Frederick  Steigman,  Chairman 

1825  West  Harrison  Street,  Chicago  60612 
Edward  DuVivier 

1900  Brown  Street,  Alton  62002 
Arthur  DeBoer 

720  North  Michigan  Ave.,  Chicago  60611 
Donald  L.  Unger 
2474  Dempster,  Des  Plaines  60016 
Joseph  H.  Kiefer 

25  East  Washington,  Chicago  60602 
Clarence  J.  Mueller 

108  West  4th  Street,  Sterling  61081 
Robert  E.  Lane 

251  East  Chicago  Ave.,  Chicago  60611 
David  Shoch 

303  East  Chicago  Ave.,  Chicago  60611 
Ernest  Lowenstein 

1123  Chestnut,  Mt.  Carmel  62863 
Newton  DuPuy 

1842  Grove,  Quincy  62301 
Thomas  J.  Collins 

8015  South  Luella  Ave.,  Chicago  60617 
Arkell  M.  Vaughn 
9012  South  Leavitt,  Chicago  60643 
William  E.  Adams 
55  East  Erie,  Chicago  60611 
Edward  P.  Cruzat 

8501  S.  Cottage  Grove,  Ghicago  60637 
L.  Martin  Hardy 

700  North  Michigan  Ave.,  Chicago  60611 


Editor:  Theodore  R.  Van  Dellen 

1000  Lake  Shore  Plaza,  Chicago  60610 
Contributing  Editors: 

John  M.  Beal 

303  East  Chicago  Ave.,  Chicago 
Leon  Love 

2160  First  Ave.,  Maywood  60153 
John  R.  Tobin,  Jr. 

2160  South  First  Ave.,  Maywood  60153 
Harvey  Kravitz 

5830  Dempster,  Morton  Grove  60053 
Resident:  Neil  Allen 

7135  Carol  St.,  Niles  60648 
State:  Richard  A.  Ott 

Responsibilities  and  Purposes: 

The  responsibilities  of  this  committee  lie  in  the  area 
of  the  editorial  content  of  the  Illinois  Medical  Journal. 
It  will  function  as  a sub-committee  of  the  Publications 
Committee.  It  shall  make  recommendations  to  the  editor 
concerning  the  scientific  content,  regular  features  and 
subjects  of  special  interest  to  the  members.  It  shall  serve 
as  a review  board  for  manuscripts  which  the  editor  be- 
lieves require  special  medical  evaluation.  It  shall  assist 
the  editor  in  any  way  possible  to  obtain  and  present 
medical  manuscripts  of  the  highest  quality  and  maximum 
interest  to  the  physicians  of  Illinois. 


AD  HOC  COMMITTEE  ON  RADIATION 
(Council  on  Environmental  and  Community  Health) 

Howard  A.  Burkhead,  Chairman 
2650  Ridge  Ave.,  Evanston  60201 
(Standby  ad  hoc  committee;  committee  members  to  be 
appointed  when  needed.) 


COMMITTEE  ON  REHABILITATION  SERVICES 


(Council  on  Social  a 

Joel  Rosen,  Chairman 

3950  Lake  Shore  Drive,  Chicago  60613 
John  E.  Finch 

135  S.  Kenilworth,  Elmhurst  60126 
Frank  B.  Kelly,  Jr. 

122  S.  Michigan  Ave.,  Chicago  60603 
Joseph  L.  Koczur 

10039  Turner,  Evergreen  Pk.,  Chicago  60642 
John  G.  Meyer 

413  W.  Monroe,  Springfield  62704 
James  C.  Reid 

712  S.  College,  Greenfield  62044 
Arthur  Rodriquez 

12800-93rd  Ave.,  Box  35,  Palos  Park  60464 


d Medical  Services) 

Consultants: 

Charles  K.  Wells 

117  N.  10th,  Mt.  Vernon  62864 
Frank  J.  Jirka,  Jr. 

1507  Keystone,  River  Forest  60305 
Staff:  Robert  Westerbeck 

Responsibilities  and  Purposes: 

The  Committee  on  Rehabilitation  Services  shall  assist 
public  and  private  agencies  in  the  establishment  of  poli- 
cies regarding  rehabilitation  facilities  and  services,  in- 
cluding training,  and  quality  and  type  of  services  avail- 
able. The  committee  also  works  closely  with  the  Gov- 
ernor’s Committee  on  Employment  of  the  Handicapped. 


COMMITTEE  ON  SCIENTIFIC  ASSEMBLY 
(Council  on  Education  and  Manpower) 


Robert  T.  Eox,  Chairman 
2136  Robin  Crest  Lane,  Glenview  60025 
J.  Robert  Thompson,  Director  of  Exhibits 
5601  N.  Pulaski,  Chicago  60646 
Roger  Hoekstra 

1530  North  Main  Street,  Wheaton  60187 
Laurel  E.  Keith 

1725  West  Harrison,  Chicago  60612 


Elizabeth  A.  McGrew 

1853  West  Polk  St.,  Chicago  60612 
Donald  L.  Unger 

2474  Dempster  St.,  Des  Plaines  60016 
S,\M.\  Representative: 

Gerald  Stanton 

11003  S.  Longwood  Dr.,  Chicago  60643 


376 


Illinois  Medical  Journal 


Auxiliary  Representative; 

Mrs.  Mitchell  Spellberg 

1212  N.  Lake  Shore,  Chicago  60611 
Staff;  Perry  L.  Smithers 

Responsibilities  and  Purposes 

The  Committee  on  Scientific  Assembly  shall  coordinate 
the  program  for  the  Annual  Convention  in  accordance 
with  Chapter  II  of  the  Constitution  and  Bylaws-/! mn/aV 
Convention;  it  shall  appoint,  with  the  approval  of  the 


Board  of  Trustees,  a secret  committee  to  make  awards  to 
the  scientific  exhibitors;  may  incorporate  in  the  annual 
scientific  meeting  those  meetings  of  medical  specialty 
groups  which  wish  to  affiliate  with  the  ISMS  annual  con- 
vention, and  shall  arrange  for  the  annual  banquet  and 
other  functions  held  during  the  annual  convention. 

The  scientific  program  shall  be  conceived  by  the  Com- 
mittee on  Scientific  Assembly  and  developed  and  imple- 
mented through  the  joint  efforts  of  the  Committee  on 
Scientific  Assembly  and  representatives  of  specialty  groups. 


ADVISORY  COMMITTEE  TO  THE  STUDENT  AMERICAN  MEDICAL  ASSOCIATION 
(Council  on  Education  and  Manpower) 


T.  Howard  Clarke,  Chairman 
999  Lake  Shore  Dr.,  Chicago  60611 
Allison  Burdick,  Jr. 

5906  W.  North  Ave.,  Chicago  60639 
N.  Kenneth  Furlong 
221  N.  East  Glen  Oak  Ave.,  Peoria 
Nathan  Iglitzen 

836  W.  Wellington,  Chicago  60657 
Courtney  P.  Jones 

11045  S.  Vincennes,  Chicago  60643 
Louis  R.  Limarzi 

910  N.  East  Ave.,  Oak  Park  60302 
Clarence  Walton 

602  W.  University  Ave.,  Urbana  61801 
SAMA  Representatives; 

Lawrence  Stone 

6217  N.  Winthrop,  Chicago  60626 
Eugene  Saltzberg 

722  W.  Grace  St.,  Chicago  60613 


Ronald  Ban 

822  S.  Miller,  Chicago  60607 
Donald  Batts 

2342  S.  59th  Ct.,  Cicero  60650 
Auxiliary  Representatut;; 

Mrs.  G.  F.  Tufo 

750  W.  Hutchinson,  Chicago  60613 
Staff;  Perry  L.  Smithers 


Responsibilities  and  Purposes 

The  committee  is  charged  with  the  responsibility  of 
maintaining  liaison  with  officers  of  Student  AMA  Chap- 
ters in  Illinois:  establishing  programs  to  acquaint  medi- 
cal students  with  the  principles  of  organized  medicine; 
and  developing  programs  designed  to  advance  the  pur- 
poses of  both  organizations. 


COMMITTEE  ON  STUDENT  LOAN  FUND 
(Council  on  Education  and  Manpower) 


Donald  Stehr,  Chairman 

102  E.  Market,  Havana  62644 
Jack  Gibbs 

24-26  Main  Street,  Canton  61520 
Charles  Salesman 

1201  N.  Allen  St.,  Robinson  62454 
Consultants; 

L.  T.  Fruin 

5 Citizen’s  Square,  Normal  61761 
Jacob  E.  Reisch 

1129  S.  2nd  St.,  Springfield  62704 
Staff;  Perry  L.  Smithers 


Responsibilities  and  Purposes 

The  committee  shall  be  responsible  to  the  Board  of 
Trustees  in  matters  related  to  administration  of  the  Stu- 
dent Loan  Program  operated  jointly  with  the  Illinois 
Agricultural  Association. 


ADVISORY  COMMITTEE  TO  THE 
DIVISION  OF  VOCATIONAL  REHABILITATION 
(Council  on  Economics  and  Peer  Review) 


Eli  Borkon,  Chairman 

Carbondale  Clinic,  Carbondale  62901 
Joseph  Compton 

4601  State  St.,  East  St.  Louis  62204 
Thomas  R.  Clatter 
5670  E.  State  St.,  Rockford  61108 
Harry  Grant 

701  N.  Walnut,  Springfield  62702 
Brian  H.  Huncke 

454  Pennsylvania  Ave.,  Glen  Ellyn  60137 


Thaddeus  S.  Pierce 

3340  S.  Oak  Park,  Berwyn  60403 
.Aaron  M.  Rosenthal 

1401  California,  Chicago  60608 
Harold  A.  Sofield 
715  Lake,  Oak  Park  60301 
A.  Walter  Wise 

502  Safety  Building,  Rock  Island  61201 
Gerald  M.  Berkowitz 

1031  Cobblestone  Ct.,  Northbrook  60062 


for  October,  1970 


377 


Consultants: 

Charles  K.  Wells 

117  N.  10th  St.,  Mt.  Vernon  62864 
Frank  J.  Jirka,  Jr. 

1507  Keystone  Ave.,  River  Forest  60305 
Staff:  Joseph  Lotharius 

Responsibilities  and  Purposes: 

The  .Advisory  Committee  to  the  Division  of  Vocational 

ADVISORY  COMMITTEE  TO 
(Board  of 

L.  T.  Fruin,  Chairman 
5 Citizen’s  Square,  Normal  61761 
J.  Ernest  Breed 

55  East  Washington,  Chicago  60602 
Willard  C.  Scrivner 

4601  State  Street,  East  St.  Louis  62205 
Staff:  Roger  N.  White 


Rehabilitation  will  meet  regularly  with  the  DVR  staff 
on  matters  regarding  the  operation  of  the  DVR  medical 
program.  It  will  submit  advisory  decisions  to  DVR  on 
medical  policy  in  the  administration  of  the  quality,  quan- 
tity and  cost  of  the  various  DVR  programs.  The  com- 
mittee should  also  foster  a good  relationship  with  DVR 
and  provide  a continuing  program  of  physician  educa- 
education  to  familiarize  ISMS  members  with  the  DVR 
program. 

THE  WOMAN'S  AUXILIARY 
Trustees) 

Responsibilities  and  Purposes: 

The  committee  shall  consist  of  the  president-elect  as 
chairman,  the  president,  the  chairman  of  the  Board.  The 
committee  shall  provide  advice  and  assistance  to  the  presi- 
dent of  the  Woman’s  Auxiliary  in  her  program  for  the 
year,  and  shall  assist  her  in  interpreting  the  activities 
of  the  state  medical  society  to  the  auxiliary  members. 


Task  Forces 

To  consider  specific  activities  and  give  full  concentration  of  council  and  staff  effort  to  a single  problem,  task  forces 
will  be  formed.  These  will  function  until  the  objective  has  been  met  and  will  then  be  dissolved.  Said  groups  will 
cross  functions  with  many  councils  and  committees  and  will  consist  of  members  of  other  councils  and  committees. 
They  will  report  directly  to  the  Board  of  Trustees. 


TASK  FORCE  ON  COMPREHENSIVE  HEALTH  PLANNING 


V.  P.  Siegel,  Chairman,  4601  State  Street,  East  St.  Louis 
62205 

Thomas  P.  deGraffenried,  1208  Sunnymeade,  DeKalb 
60115 

John  Howard  Kendall,  502  W.  Palladium  Drive,  Joliet 
60431 

Philip  Lynch,  1314  North  Main,  Decatur 
E.  A.  Piszczek,  6410  North  Leona  Avenue,  Chicago  60646 
Fred  Z.  White,  723  North  2nd,  Chillicothe 
Consultants: 

Clarke  Mangum,  535  North  Dearborn,  Chicago  (AMA) 
Clifton  Reeder,  734  North  Merrill,  Park  Ridge  60068 
Frank  J.  Jirka,  Jr.,  1507  Keystone,  River  Forest  60305 
Thomas  Harwood,  4902  Tollview  Dr.,  Rolling  Meadows 
60008 

Staff:  H.  Michael  Wild 


Responsibilities  and  Purposes 

1.  To  keep  abreast  of  all  developments  in  the  State  of 
Illinois  with  respect  to  Comprehensive  Health  Planning. 

2.  To  make  recommendations  as  to  the  manner  in  which 
ISMS  can  initiate  and  maintain  a position  of  leadership 
in  Comprehensive  Health  Planning. 

3.  To  establish  and  maintain  a close  liaison  with  the 
official  state  agency  designated  to  administer  the  law. 


TASK  FORCE  ON  PHYSICIAN  SHORTAGE 
AND 

SERVICES  TO  MEDICALLY  DEPRIVED  AREAS 


William  M.  Lees,  Chairman 
6518  N.  Noklmis,  Lincolnwood  60646 
Philip  G.  Thomsen 
13826  Lincoln  Ave.,  Dolton  60419 
Jack  Gibbs 

24-26  Main  Street,  Canton  61520 
Morgan  Meyer 

815  S.  Main,  Lombard  60148 
Eugene  Johnson 
22  W.  Main,  Casey  62420 
Robert  Freeark 
803  Lake,  Wilmette  60091 
Thomas  A.  Reardon 

1926  W.  Harrison  Chicago 
Alfred  J.  Faber 

2110  Swainwood  Dr.,  Glenview  60025 
Matthew  Eisele 

(Kil  Mar  Medical  Bldg.) 

8601  W.  Main  (Suite  209) 

Belleville  62223 


Donald  Stehr 

102  E.  Market  Havana  62644 
Andrew  Brislen 

6060  S.  Drexel,  Chicago  60637 
George  Shropshear 

1525  E.  53rd  St.,  Chicago  60615 
Consultant: 

James  B.  Hartney 

410  Lake  St.  Oak  Park  60302 
Staff:  Jim  Slawny 

Responsibilities  and  Purposes: 

The  primary  responsibilities  of  the  task  force  are  to 
initiate  and  implement  programs  to  alleviate  the  physi- 
cian shortage  in  Illinois— particularly  in  rural  areas— and 
to  assist  in  the  development  of  projects  to  improve  the 
health  care  of  people  in  medically  deprived  areas,  such 
as  urban  ghettos.  It  is  also  charged  with  the  responsi- 
bility of  developing  a loan  program  for  “inner  city” 
medical  students. 


378 


Illinois  Medical  Journal 


OTHER  APPOINTMENTS 

The  Board  of  Directors  of  the  Educational  and  Scientific  Foundation,  and  representatives  to  other 
organizations  report  directly  to  the  Board  of  Trustees  periodically  as  necessary. 


EDUCATIONAL  AND  SCIENTIFIC  FOUNDATION 


Edward  W.  Cannady,  Chairman 
4601  State  St.,  E.  St.  Louis  62205 
Willard  C.  Scrivner 
4601  State  St.,  E.  St.  Louis  62205 
J.  Ernest  Breed 

55  E.  Washington  St.,  Chicago  60602 
L.  T.  Fruin  j 

5 Citizen’s  Square,  Normal  61761 
Jacob  E.  Reisch 

1129  S.  2nd  St.,  Springfield  62704 
Staff:  Perry  Smithers 

Responsibilities  and  Purposes 

The  foundation  was  founded  to  provide  an  ad- 


ministrative agency  to  foster  the  advancement  of 
medical  science  through  ( 1 ) the  initiation  of  scien- 
tific and  medical  research  activities,  (2)  the 
collection,  evaluation  and  dissemination  of  the 
results  of  research  activities  to  the  public  and  (3) 
the  implementation  and  management  of  projects 
related  to  medicine  for  individuals  or  organizations 
seeking  to  inform  or  educate  others,  or  to  improve 
their  own  knowledge.  The  charter  of  the  founda- 
tion calls  for  a board  of  directors  consisting  of  the 
following  officers  of  the  Illinois  State  Medical 
Society:  Immediate  Past  President  (as  chairman), 
Chairman  of  the  Board  of  Trustees,  President, 
and  Secretary -Treasurer. 


REPRESENTATIVES 


ILLINOIS  ASSOCIATION  OF  THE  PROFESSIONS  (lAP) 

Frank  J.  Jirka,  Jr.,  1507  Keystone  Ave.,  River  Forest  60305 
William  M.  Lees,  6518  North  Nokomis,  Lincolnwood  60646 
SWANBERG  FOUNDATION,  QUINCY 

Arkell  M.  Vaughn,  9012  S.  Leavitt,  Chicago  60620 
HEALTH  CAREERS  COUNCIL  OF  ILLINOIS  (HCCI) 

Eugene  P..  Johnson,  22  West  Main  St.,  Casey  62420  (HCCI  Board) 

Allison  Burdick,  Jr.,  5906  West  North  Avenue,  Chicago  60639  (HCCI  Board) 
Casper  Epsteen,  25  East  Washington,  Chicago  60602  (Del.  HCCI  Senate) 

Carl  E.  Clark,  225  Edward,  Sycamore  60178  (Del.  HCCI  Senate) 

MIDWEST  REGIONAL  LIBRARY  ASSOCIATION 
William  E.  Adams,  55  E.  Erie  St.,  Chicago  60611 
LIAISON  TO  ILLINOIS  MEDICAL  ASSISTANTS  ASSOCIATION 
Carl  E.  Clark,  225  Edward  St.,  Sycamore  60178 


for  October,  1970 


379 


COMMITTEE  INDEX 


Committee 

Aging 

Alcoholism 

Allied  Health  Education 

Benevolence 

Child  Health 

Committees,  Committee  on 

Comprehensive  Health  Planning,  Task  Force 

Constitution  & Bylaws 

Continuing  Education 

Drugs  & Therapeutics,  Sub-Committee 

Editorial  Board,  Sub-Committee 

Educational  & Scientific  Foundation,  Repr.  to 

Ethical  Relations 

Executive 

Ear,  Nose  and  Throat  Health 

Eye  Health 

Finance 

Health  Care  Financing 

Health  Careers  Council,  Repr.  to 

Hospital  Relations,  ad  hoc 

Impartial  Medical  Testimony 

LAP,  Repr.  to 

Insurance 

Laboratory  Services 

Licensure 

Maternal  Welfare 

Medical  Assistants  Assn.,  Liaison 

Medicine  and  Religion 

Narcotics 

Nursing 

Nutrition 

Osteopathic  Problems,  to  study 
Physician  Shortage  and  Services  to 
Medically  Deprived  Areas  Task  Force 
Policy 

Public  Affairs 
Publications 
Public  Safety 
Radiation,  ad  hoc 
Rehabilitation  Services 
Scientific  Assembly 
SAMA,  Adv.  to 
Student  Loan  Fund 
Vocational  Rehabilitation, 

Med.  Adv.  to  Dept,  of 
Woman’s  Auxiliary,  Adv.  to 


Council  Poge 

Social  and  Medical  Services  366 

Mental  Health  and  Addiction  366 

Education  and  Manpower  366 

Board  of  Trustees  367 

Environmental  and  Community  Health  367 

Board  of  Trustees  368 

Board  of  Trustees  378 

Board  of  Trustees  368 

Education  and  Manpower  368 

Board  of  Trustees  369 

Board  of  Trustees  376 

Board  of  Trustees  379 

Board  of  Trustees  369 

Board  of  Trustees  369 

Legislation  & Public  Affairs  370 

Legislation  and  Public  Affairs  370 

Board  of  Trustees  370 

Board  of  Trustees  371 

Board  of  Trustees  379 

Social  and  Medical  Services  371 

Medical-Legal  371 

Board  of  Trustees  379 

Public  Relations  and  Membership  Service  371 

Medical-Legal  372 

Medical-Legal  372 

Environmental  and  Community  Health  372 

Board  of  Trustees  379 

Public  Relations  and  Membership  Services  373 
Mental  Health  and  Addiction  373 

Social  and  Medical  Services  374 

Environmental  and  Community  Health  374 

Board  of  Trustees  374 

Board  of  Trustees  378 

Board  of  Trustees  374 

Legislation  & Public  Affairs  375 

Board  of  Trustees  375 

Environmental  and  Community  Health  375 

Environmental  and  Community  Health  376 

Social  and  Medical  Services  376 

Education  and  Manpower  376 

Education  and  Manpower  377 

Education  and  Manpower  377 

Economics  and  Peer  Review  377 

Board  of  Trustees  378 


380 


Illinois  Medical  Journal 


ISMS  SERVICES 


Pursuit  of  Obligations 

Purposes  of  the  Illinois  State  Medical  So- 
ciety are: 

• to  promote  the  science  and  art  of  medicine 

• to  protect  the  public  health 

• to  evaluate  standards  of  medical  education 

• to  unite  the  medical  profession  behind  these 
purposes 

• to  unite  with  similar  organizations  in  other 
states  and  territories  of  the  United  States  to 
form  the  American  Medical  Association. 

The  Society  shall  inform  the  public  and  the  pro- 
fession concerning  the  advancements  in  medical 
science  and  the  advantages  of  proper  medical  care. 

To  fulfill  these  purposes,  the  Society  maintains 
a headquarters  office  at  360  N.  Michigan  Ave., 
Chicago,  and  an  office  in  Springfield  at  520  S. 
Sixth  St.  Services  of  the  Society,  under  the  gen- 


eral supervision  of  Roger  N.  White,  Executive 
Administrator,  are  conducted  by  the  following 
divisions: 

Administration;  Public  Relations  and  Econom- 
ics; Legislation  and  Public  Affairs;  Publications; 
and  Educational  and  Scientific  Services. 

Many  and  varied  are  the  activities  of  the 
Society  in  pursuit  of  its  obligations.  Some  of 
these  activities  are  major  programs  of  statewide 
(and  sometimes  national)  interest  for  all  citizens; 
others  are  of  special  interest  to  doctors;  still 
others  are  sponsored  for  specific  groups  or  in- 
dividuals. 

Following  are  descriptions  of  the  Society’s 
divisions  and  the  programs,  services  and  publi- 
cations available  directly  to  Society  members  or 
sponsored  for  their  benefit. 


DIVISION  OF  ADMINISTRATION 


The  Executive  Administrator  has  the  respon- 
sibility and  the  authority  to  provide  for  the 
smooth  and  efficient  functioning  of  the  Illinois 
State  Medical  Society. 

The  implementation  of  established  policy,  fiscal 
and  budgetary  matters,  the  employment  of  quali- 
fied personnel  and  the  development  and  mainten- 
ance of  personnel  policies  are  all  part  of  the 
Administrator’s  activities. 

He  maintains  liaison  with  the  Board  of  Trus- 
tees and  assists  the  chairman  in  carrying  out  his 
duties.  Close  cooperation  with  the  speaker  of  the 
House  of  Delegates  and  the  officers  of  the  Society 
provides  a smooth  and  efficient  atmosphere  in 
which  the  Society  may  function.  Cooperation  is 
maintained  with  the  Committee  on  Constitution 
and  Bylaws  to  present  to  the  House  all  suggested 
changes  for  official  action.  The  Administrator 
channels  all  legal  inquiries  and  works  with  the 


DIVISION  OF  EDUCATIONAL 

Committee  Responsibilities 

This  division  provides  staff  services  for  the 
Council  on  Education  and  Manpower,  the  Coun- 
cil on  Environmental  and  Community  Health, 
the  Council  on  Mental  Health  and  Addiction, 
and  the  eleven  committees  assigned  to  these  coun- 
cils. 

Annual  Convention 

Similarly,  the  staff  serves  as  an  arm  of  the 
Committee  on  Scientific  Assembly  to  arrange  and 


General  Legal  Counsel  to  provide  guidance  to 
the  officers,  trustees,  committee  chairmen  and 
county  medical  society  officers. 

To  provide  the  membership  of  the  Society  with 
the  best  professional  staff  services  available,  head- 
quarters has  been  set  up  by  divisions.  The  Divi- 
sion of  Administration  provides  the  business  serv- 
ices of  the  Society  including  the  safekeeping  and 
proper  accounting  for  all  money  and  securities 
under  the  guidance  of  the  Board  of  Trustees, 
Finance  Committee  and  the  Secretary-Treasurer. 
A Field  Services  Representative  is  maintained 
within  the  Division  to  assist  the  Trustees  in  pro- 
viding liaison  between  the  Headquarters  office 
and  the  county  medical  societies. 

The  Division  also  maintains  the  membership 
records  and  provides  a computerized  central  dues 
billing  and  collection  service  for  county  medical 
societies. 


AND  SCIENTIFIC  SERVICES 

produce  the  annual  convention  of  ISMS.  Held  in 
May  each  year,  the  convention  offers  scientific 
meetings  and  exhibits  as  well  as  sessions  of  the 
House  of  Delegates. 

An  additional  function  of  the  division  is  to  ad- 
minister the  affairs  of  the  Educational  and  Scien- 
tific Foundation,  a non-profit  organization  estab- 
lished to  conduct  educational  and  scientific  projects 
related  to  medicine.  Physicians  are  invited  to 
become  Fellows  of  the  Foundation  for  a charter 
membership  of  $100. 


for  October,  1970 


381 


DIVISION  OF  LEGISLATION  AND  PUBLIC  AFFAIRS 


As  professional  medicine  strives  to  maintain 
the  vigorous  condition  of  the  public  health,  the 
profession  is  vitally  and  intimately  concerned 
with  legislative  actions  of  the  Illinois  General 
Assembly  and  the  U.  S.  Congress  which  affect 
physicians,  other  members  of  the  healing  arts, 
and  the  lay  public.  To  insure  that  the  best  health 
interests  of  the  public  and  professional  interests 
of  the  physician  are  served,  the  Division  monitors 
all  state  and  national  legislation  which  affect  the 
health  of  the  individual  and  his  community. 

The  monitoring  process  is  designed  to  present 
the  thoughtful  views  of  professional  medicine  in 
Illinois  on  specific  medically  related  pieces  of  leg- 
islation. 

The  ISMS  Council  on  Legislation  and  Public 
Affairs  acts  as  the  clearing  house  for  legislative 
proposals  recommended  by  specialized  ISMS  com- 
mittees; generated  by  allied  groups;  produced  by 
special  interests  and  introduced  by  representatives 
and  senators.  Such  legislation  is  thoroughly  ana- 
lyzed by  physician-members  of  the  specialized 
ISMS  committee  covering  the  subject  matter  of 
the  introduced  legislation. 

Support  or  Oppose  Legislation 

Upon  appropriate  consideration  and  recom- 
mendation. legislation  of  medical  significance  in 
the  Illinois  Legislature  is  either  supported  or 
opposed  to  protect  and  promote  the  interests  of 
the  public  and  the  profession.  Pertinent  subject 
matter  testimony  is  presented  before  the  House 
and  Senate  committees  as  the  bill  proceeds 
through  the  legislative  process. 

On-the-scene  surveillance  of  monitored  legis- 

DIVISION  OF 

The  Division  of  Publications  is  charged  with 
the  total  production  of  all  printed  materials  and 
publications  as  well  as  the  distribution  of  these 
items. 

Principal  among  the  publications  is  the  official 
organ  of  the  society,  the  Illinois  Medical  Jour- 
nal. The  Journal  is  mailed  monthly  to  all  mem- 
bers who  are  urged  to  read  it  to  keep  abreast 
of  the  scientific,  economic,  political,  legal  and 
social  developments  within  the  state.  The  editor 
welcomes  suggestions  for  articles  which  may  be 
of  special  interest  to  the  membership.  All  mem- 
bers should  consider  the  IMJ  a means  of  com- 
municating with  fellow  Illinois  practitioners. 

Other  publications  are  Pulse,  a monthly  news- 
letter, and  such  other  special  publications,  bro- 
chures, pamphlets,  flyers  and  letters  as  are  re- 
quired by  the  several  ISMS  divisions  to  carry 
forth  their  mission. 

Within  the  division  responsibility  is  maintained 
for  all  printing  and  duplicating  services  for  the 
society;  a small  in-plant  print  shop  is  maintained 
along  with  modern  reproduction  and  collating 
equipment. 


lation  is  maintained  by  ISMS  legislative  rep- 
resentatives. 

Through  these  essential  actions,  ISMS  plays  a 
meaningful  role  in  shaping  legislation  for  the 
betterment  of  the  people  of  Illinois. 

Action  similar  to  the  above  is  taken  with  re- 
spect to  bills  in  Congress  when  they  have  special 
significance  to  Illinois  physicians.  This  activity  is 
conducted  in  concert  with  the  American  Medical 
Association. 

Integrated  with  and  designed  to  augment  the 
legislative  activity  is  the  Public  Affairs  Program. 
This  program,  executed  by  the  Division  of  Leg- 
islation and  Public  Affairs,  as  directed  by  the 
ISMS  Public  Affairs  Committee,  strives  to  alert 
the  physician  to  his  role  in  public  affairs  and  to 
involve  him  in  effective  participation  in  public 
affairs  in  his  community,  state,  and  nation. 
Other  Activities 

Divisional  activities  also  includes  other  services. 
One  of  these,  involving  medicine,  law,  and  the 
judiciary,  is  the  administration  of  the  Impartial 
Medical  Testimony  program.  Operating  in  con- 
junction with  the  Supreme  Court  of  Illinois  and 
the  Federal  District  Court,  the  services  of  im- 
partial medical  examiners  are  provided  in  per- 
sonal injury  cases. 

Other  facets  of  medical-legal  interaction  are 
explored  through  the  Medical-Legal  Council  and 
problems  resolved  through  liaison  witt^,  commit- 
tees of  the  judicial  and  the  bar  associations. 

In  addition  to  the  foregoing,  the  division  staffs 
the  Committees  on  Laboratory  Services,  Licen- 
sure, Eye  Health,  and  Ear,  Nose  and  Throat 
Health. 

PUBLICATIONS 

In  addition  all  mail  room  services  are  pro- 
vided by  this  division.  An  addressograph  and 
graphotype  are  utilized  as  well  as  a small  wing 
mailer,  folder  and  stuffing  machine,  and  a plate 
burning  cabinet.  Mailing  is  accomplished  through 
use  of  computer-supplied  labels  and  the  addresso- 
graph. 

Within  the  Illinois  Medical  Journal  and  for 
Pulse  commercial  advertising  is  carried.  The 
maintenance  of  the  records  of  advertisers,  in- 
sertion orders,  contracts,  and  direct  communi- 
cation and  liaison  with  advertising  agencies  and 
pharmaceutical  houses  fall  within  the  purview  of 
the  division.  These  are  accomplished  through  an 
advertising  manager.  Through  this  means  and 
the  ISMS  representatives,  the  opportunity  of  pre- 
senting a product  to  members  of  ISMS  through 
advertising  in  ISMS  publications  is  offered. 

Staff  services  for  the  Publications  Committee 
and  the  Editorial  Board  are  furnished  through 
the  division.  Needs  of  groups  affiliated  with  or 
ancillary  to  ISMS  insofar  as  reproduction  fa- 
cilities are  concerned  are  also  handled  through 
the  division  office. 


382 


Illinois  Medical  Journal 


DIVISION  OF  PUBLIC  RELATIONS  AND  ECONOMICS 


The  Public  Relations  and  Economics  Division 
serves  both  as  a news  outlet  to  the  press,  and  as 
a source  of  information  on  socio-economic  and 
insurance  matters  to  the  membership. 

With  increasing  frequency,  the  division  is  con- 
tacted by  news  writers  seeking  information  on 
socio-economic,  as  well  as  scientific  subjects.  Its 
counseling  services  on  public  relations  and 
publicity  are  available  to  any  county  medical 
society. 

The  division  also  prepares  speeches,  publishes 
pamphlets  and  other  materials  on  subjects  such 
as  public  aid  in  Illinois,  medical  care  financing 
through  Social  Security,  and  physician  retirement 
programs. 

News  Releases 

A mailing  list  of  all  Illinois  newspapers,  radio 
and  television  station^  is  maintained  by  the  di- 
vision. The  list  is  so  arranged  that  news  releases 
may  be  addressed  to  individual  counties,  and 
county  society  secretaries  may  avail  themselves 
of  this  service. 

News  releases  for  county  societies  are  auto- 
matically prepared  by  the  division  staff  and  dis- 
tributed to  all  news  outlets  in  the  particular 
county  whenever  a county  society  makes  use  of 


the  ISMS  post-graduate  education  program.  Other 
than  this,  the  state  society’s  staff  does  not  pre- 
pare news  releases  of  county  society  activities 
unless  this  service  is  specifically  requested. 

Health  Columns  for  Newspapers 

Currently,  ISMS  presents  daily  public  serv- 
ice health  columns  entitled  “Dr.  SIMS  Says.” 
These  columns,  offered  to  the  700  newspapers 
in  Illinois,  carry  the  logotype  of  Dr.  “SIMS” 
which  readily  identifies  the  column  with  the 
Illinois  State  Medical  Society, 

Another  public  service  column,  being  carried 
by  some  375  high  school  newspapers  throughout 
Illinois,  is  entitled  “Dr.  SIMS  Talks  to  Teens.” 
It  is  distributed  on  a monthly  basis. 

Public  Aid  Liaison 

Familiarity  with  the  medical  care  programs 
of  the  Illinois  Department  of  Public  Aid  and 
liaison  with  the  staff  of  the  department  are  other 
responsibilities  of  the  Division  of  Public  Rela- 
tions and  Economics.  Liaison  is  also  maintained 
with  public  and  private  agencies  interested  in  the 
fields  of  aging,  insurance,  hospitals,  and  re- 
habilitation. 

The  division  provides  staff  services  to  the 
Councils  on  Economics  and  Peer  Review,  Social 
and  Medical  Services,  and  Public  Relations  and 
Membership  Services,  as  well  as  the  Task  Force  on 
Physician  Shortage  and  Medically  Deprived  Areas. 


THE  EDUCATIONAL  & SCIENTIFIC  FOUNDATION 

The  Educational  & Scientific  Foundation  was 
founded  to  provide  an  administrative  agency  to 
foster  the  advancement  of  clinical  science  through: 

1)  The  initiation  of  scientific  and  medical  re- 
search activities. 

2)  The  collection,  evaluation  and  dissemination 
of  the  results  of  research  activities  to  the  public. 

3)  The  implementation  and  management  of 
projects  related  to  medicine  for  individuals  or 
organizations  seeking  to  inform  or  educate  others, 
or  to  improve  their  own  knowledge. 

The  Foundation  is  a distinct  corporate  entity 
which  has  an  interlocking  Board  with  the  Illinois 
State  Medical  Society.  It  is  staffed  through  ISMS 
headquarters. 


for  October,  1970 


383 


FILMS 


Stroke — Early  Restorative  Measures 
in  Your  Hospital 

A film  entitled  “Stroke — Early  Restorative 
Measures  in  Your  Hospital,”  produced  by  the 
ISMS  Committee  on  Aging,  is  available  from  the 
Society. 

Directed  toward  physicians  in  all  general  hos- 
pitals, regardless  of  size,  the  film  illustrates  simple 
and  effective  methods  and  devices  used  in  the  re- 
habilitation of  stroke  patients.  It  emphasizes  the 
procedures  to  be  instituted  immediately  upon 
the  patient’s  admission  to  the  hospital. 

Primary  purpose  of  the  film  is  to  inform  physi- 
cians and  nurses  of  the  need  for  Immediate 
action  in  stroke  cases  and  to  interest  them  in 
acquiring  additional  details  for  treatment  through 
available  publications  or  study  courses.  The  20- 
minute  sound,  color  film  illustrates  a program 
of  constructive  rehabilitation  which  may  be  con- 
ducted in  any  hospital,  however  small,  by  an  in- 
terested nurse  using  a minimum  of  equipment. 

The  film  may  be  obtained  from  the  Society 
on  a loan  basis  for  viewing  without  charge  or  may 
be  purchased  for  $125. 

Modern  Management  of  Multiple  Births 

“Modern  Management  of  Multiple  Births”  is  a 
16  mm.  sound-color  motion  picture  produced  by 
the  Educational  and  Scientific  Foundation  of  the 
Illinois  State  Medical  Society  in  cooperation  with 
Lederle  Laboratories  Division  of  American  Cyana- 
mid  Co. 

Teaching  “heart”  of  the  film  is  step-by-step 
reconstruction  of  an  elaborate  protocol  which 
serves  as  a standard  of  prenatal  planning  for 


any  physician  faced  with  the  management  of 
multiple  pregnancy. 

For  added  teaching  interest,  the  film  reviews 
birth  of  identical  quadruplets,  showing  how 
identicality  was  established  with  major  and  minor 
blood  typings,  examination  of  placenta  and  fetal 
membranes  and  other  procedures.  There  are  also 
scenes  of  actual  delivery  of  quadruplets. 

Showings  of  the  film  are  restricted  to  profes- 
sional audiences.  Organizations  may  borrow  the 
film  from  Lederle  Laboratories  Film  Library,  Pearl 
River,  N.  Y.,  or  from  the  Illinois  State  Medical 
Society,  360  N.  Michigan  Ave.,  Chicago  60601. 

The  Time  of  Your  Life 

A 13-part,  16  mm.,  black-and-white  sound  film 
is  available  to  industry,  church  and  civic  groups, 
fraternal  organizations,  and  medical  societies, 
dealing  with  planning  and  participating  in  a hap- 
py, secure  retirement.  Successfully  aired  over  TV, 
the  video  tapes  have  been  converted  to  film  for 
rental  or  purchase  at  $60  for  the  former  and 
$975  for  the  latter. 

This  is  a self-contained  educational  package 
which  provides  a once-in-a-lifetime  opportunity 
for  organizations  to  reach  people  who  might 
otherwise  be  deprived  of  vital  training  in  retire- 
ment planning.  Since  about  one  out  of  every 
three  Americans  will  be  retired  within  a genera- 
tion it  is  essential  that  this  message  be  put  across 
to  obviate  unnecessary  wasting  of  human  resources 
and  economic  resources  among  the  retired. 

The  film  is  available  through  the  Division  of 
Public  Relations,  ISMS. 


SPECIAL  PUBLICATIONS 


Pulse 

Pulse  is  a monthly  newsletter  published  by  the 
Illinois  State  Medical  Society  under  a grant  from 
Roche  Laboratories,  Division  of  Hoffmann  La- 
Roche,  Inc.  It  is  distributed  to  all  doctors  in  the 
state,  to  members  of  the  Woman’s  Auxiliary  and 
Illinois  Medical  Assistants  Association,  and  is 
supplied  in  quantity  to  hospitals  for  interns,  resi- 
dents and  other  personnel. 

Pulse  carries  non-scientific  news,  photographs 
and  feature  materials  of  interest  to  the  medical 
profession  in  Illinois.  A special  section  is  devoted 
to  the  activities  of  the  Woman’s  Auxiliary. 

Comb-1  Insurance  Form 

Because  of  the  variety  of  data  required  for 
health  insurance  claims,  the  Comb-1  Form  was 
developed  jointly  by  the  American  Medical  As- 
sociation and  the  Health  Insurance  Council  to 
simplify  and  reduce  the  number  of  attending 


physicians  forms  equally  acceptable  to  the  health 
insurance  industry  and  the  medical  profession. 

Information  requested  by  many  diverse  forms 
from  a large  number  of  Insurance  companies  was 
first  classified  and  minimum  needs  for  claim 
purposes  were  determined.  Then  appropriate  and 
clearly  worded  questions  were  developed  and 
arranged  in  a standard  sequence,  to  facilitate  com- 
pletion. Out  of  this  came  two  basic  forms,  one 
for  group  health  insurance  and  one  for  individual 
health  insurance,  and  four  abbreviated  forms.  A 
further  simplification  involved  devising  an  all- 
purpose form  which  is  a combination  of  the 
group  and  individual  forms — the  Comb-1  Simpli- 
fied Health  Insurance  Claim  Form. 

These  forms  are  available  to  physicians  from 
the  Illinois  State  Medical  Society  and  should  be 
substituted  for  any  non-standardized  forms  re- 
ceived. Each  physician  has  been  asked  to  vol- 
untarily adopt  the  following  procedure: 

1 > When  a physician  receives  a form  from  an 


384 


lUhiois  Medical  Journal 


insurance  company  bearing  the  HIC  symbol 
it  should  be  completed  and  returned  to  the 
company. 

2)  When  a physician  receives  a form  not  iden- 
tified by  the  HIC  symbol,  the  standardized 
form  should  be  filled  out  and  clipped  to  the 
unacceptable  form  with  both  forms  returned 
to  the  insurance  company. 

3 ) If  the  insurance  company  insists  upon  having 
its  own  form  completed,  the  doctor  should 
feel  justified  in  making  a reasonable  charge 
for  the  added  work  involved  in  handling 
the  non-standardized  form. 

The  attempt  to  standardize  these  forms  is  an 
aid  in  cutting  back  on  the  ever-increasing  load  of 
paper  work  involved  in  medical  practice.  Forms 
are  available  without  charge  from  the  ISMS  Di- 
vision of  Public  Relations  and  Economics  while 
the  supply  lasts. 

Disaster  Hospital  Manual 

The  responsibility  of  providing  immediate  medi- 
cal and  hospital  care  in  disasters  of  any  magni- 
tude falls  directly  on  physicians,  nurses  and  hos- 
pitals. To  aid  Illinois  communities  in  developing 


disaster  plans,  the  ISMS  Committee  on  Disaster 
Medical  Care  has  adopted  a model  emergency 
plan  for  hospitals. 

Originally  developed  by  the  Memorial  Hospital 
of  DuPage  County,  Elmhurst,  the  plan  is  recog- 
nized as  a model  by  the  Office  of  Defense 
Mobilization  in  Washington,  D.  C.  Copies  are 
available  from  the  Society. 

Medical  Career  Recruitment  Programs 

As  man  has  advanced  his  life  expectancy,  it  fol- 
lows that  many  additional  young  men  and  women 
are  and  will  be  needed  as  members  of  the  health 
team.  Youth  must  be  counseled  early  in  their 
academic  years  in  order  to  receive  the  proper 
educational  background  for  a doctorate  of  medi- 
cine or  allied  health  field  degree. 

The  Woman’s  Auxiliary  of  the  ISMS  has  been 
the  spearhead  force  in  Illinois  to  interest  and 
recruit  the  youth  of  the  state  in  medical  careers. 
Members  are  asked  to  aid  this  effort  by  investi- 
gating the  possibility  of  conducting  or  participat- 
ing in  career  days  in  their  home  communities. 

A paperback  book  entitled  “Horizons  Un- 
limited” is  available  from  the  Society. 


SCIENTIFIC  SPEAKERS  BUREAU 


The  Illinois  State  Medical  Society,  through  its 
Scientific  Speakers  Bureau,  aids  county  societies 
in  their  efforts  to  keep  members  abreast  of  medi- 
cal advances.  Sponsored  by  the  ISMS  Committee 
on  Continuing  Education,  the  bureau  helps  local 
groups  arrange  and  conduct  postgraduate  medical 
education  programs  in  their  own  areas.  This  as- 
sistance includes  obtaining  speakers,  helping  them 
with  travel  arrangements,  preparing  and  mail- 
ing notices  of  meetings,  and  paying  an  honorarium 
and  travel  expenses.  ISMS  can  also  provide  pub- 
licity services  upon  request. 

It  also  pays  a $50  honorarium  and  expenses  for 
individual  speakers  obtained  by  county  medical 
societies  for  their  regular  meetings. 

The  Bureau  operates  under  a grant  from  Merck, 
Sharp  & Dohme,  which  provides  funds  to  the 
ISMS  Educational  and  Scientific  Foundation  for 
the  specific  purpose  of  obtaining  speakers  for 
county  medical  society  meetings. 

The  following  procedures  govern  use  of  the 
Bureau: 


1)  County  societies  select  speakers  from  a 
roster  containing  the  names  of  more  than  400 
speakers  and  over  1,000  topics. 

2)  Eight  weeks  advance  notice  is  required  for 
postgraduate  meetings.  Requests  for  such  meet- 
ings, which  usually  are  scheduled  for  an  entire 
afternoon,  should  be  sent  to  the  chairman  of  the 
Committee  on  Continuing  Education,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave.,  Chicago. 

3)  Publicity  to  media  in  the  area  of  the 
meeting  will  be  handled  by  ISMS  upon  request 
of  the  county  society. 

4)  Postcard  notices  will  be  mailed  to  physicians 
in  the  county  if  requested.  ISMS  will  prepare  and 
mail  notices  if  the  information  is  received  no  less 
than  three  weeks  prior  to  the  meeting. 

5)  The  county  medical  society  program  chair- 
man and  the  speaker  are  both  expected  to  sub- 
mit to  ISMS  a report  on  the  meeting  and  the 
arrangements. 


PHYSICIANS  PLACEMENT  & STUDENT  LOAN  FUND  PROGRAM 

The  Illinois  State  Medical  Society  not  only 
offers  help  to  students  who  wish  to  become  physi- 
cians, but  also  is  able  to  assist  the  careers  of  those 
already  licensed  to  practice  medicine. 

The  society  provides  this  aid  through  two  spe- 
cial activities.  First  is  its  own  Physicians  Place- 
ment Service.  Second  is  the  Illinois  Medical  Stu- 
dent Loan  Fund  Program  that  the  society  sponsors 
in  conjunction  with  the  Illinois  Agricultural  As- 
sociation. 


/or  October,  1970 


385 


Physicians  Placement  Service 


The  Physicians  Placement  Service  is  designed  to 
help  physicians  find  a desirable  area  in  which  to 
establish  practice  or  to  relocate.  The  program’s 
purpose  is  twofold,  since  it  is  interested  also  in 
helping  those  communities  which  demonstrate 
need  of  a resident  physician. 

More  than  450  medical  doctors  have  been 
placed  through  this  program  since  its  inception 
shortly  after  World  War  II. 

The  Physicians  Placement  Service  maintains  an 
up-to-date  listing  of  some  150  “open”  areas  need- 
ing general  practitioners.  It  maintains  a similar 
listing  of  areas  in  need  of  specialists  in  a given 
field. 

This  service  accepts  requests  from  both  physi- 
cians and  communities  for  satisfactory  placement. 
In  addition,  physicians  are  referred  to  the  service 
by  a number  of  organizations,  among  them  the 
American  Medical  Association,  the  Illinois  State 
Health  Department  and  the  Illinois  Agricultural 
Association.  Frequently,  responsible  citizens  or 


overburdened  physicians  in  a community  will  con- 
tact the  service. 

Another  important  function  of  the  Physicians 
Placement  Service  is  to  assist  small  communities 
in  developing  programs  to  attract  physicians. 

The  Physicians  Placement  Service  sends  a ques- 
tionnaire to  the  applicant  physician  to  obtain  in- 
formation on  his  educational  background,  his  in- 
terests and  preferences  of  type  of  practice.  Upon 
return  of  the  questionnaire,  the  physician  is  sent 
a complete  list  of  openings.  Each  opening  is  de- 
tailed on  its  facilities  for  home  life,  office  space, 
proximity  to  hospital  facilities  and  other  specifics. 
The  physician  is  also  sent  bulletins  with  infor- 
mation on  new  locations  as  they  develop. 

The  Physicians  Placement  Service  offers  its  as- 
sistance to  all  qualified  physicians  who  request  it. 
An  applicant  need  not  be  a member  of  the  state 
medical  society.  There  is  no  charge  either  to  the 
physician  or  to  the  community  seeking  the  services 
of  this  program. 


Illinois  Medical  Student 

The  Illinois  Medical  Student  Loan  Fund  Pro- 
gram is  designed  to  help  those  who  have  what 
it  takes  to  become  a physician  but  lack  sufficient 
financial  resources  or  a recommendation  for  medi- 
cal school. 

Loans  to  students  in  need  are  provided  by  joint 
contributions  from  the  Illinois  State  Medical  So- 
ciety and  the  Illinois  Agricultural  Association.  The 
program  offers  loans  of  $750  per  semester — up  to 
a total  of  $7,500  over  a five-year  period.  A two 
per  cent  interest  rate  is  charged  semi-annually 
from  the  time  the  loan  is  received.  The  borrower 
must  also  insure  himself  for  the  entire  amount  of 
the  loan  and  pay  premiums  on  the  policy.  Re- 
payment begins  January  1 of  the  fifth  year  fol- 
lowing medical  school  graduation. 

The  program  also  offers  assistance  to  those  who 
may  not  have  financial  difficulties  but  can’t  get 
into  a “Class  A”  medical  school  because  their 
college  grades  are  marginal.  The  board  represent- 
ing the  sponsoring  organizations  of  the  program 
can  recommend  10  or  more  candidates  annually  to 
the  University  of  Illinois  College  of  Medicine  in 
Chicago.  After  careful  screening  to  determine 
whether  the  applicant  has  the  potential  to  make  a 
good  medical  student,  the  board  can  recommend 
him  for  admittance  on  the  basis  of  its  investigation. 

In  return  for  this  assistance  from  the  Medical 
Student  Loan  Fund  Program,  the  applicant  must 


Loan  Fund  Program 

agree  to  practice  medicine  in  an  Illinois  town — 
serving  a rural  population  for  five  years.  The 
applicant  may  select  a town  from  an  up-to-date 
list  of  communities  which  have  demonstrated  need 
and  ability  to  support  a physician,  but  choice  is 
subject  to  approval  by  the  program’s  board.  The 
purpose  of  this  agreement  is  to  provide  family 
doctors  for  the  rural  communities  in  Illinois. 

To  be  considered  for  assistance  from  the  Med- 
ical Student  Loan  Fund  Program,  an  applicant 
must  be  recommended  by  the  presidents  of  his 
home  county  medical  society  and  farm  bureau. 
Rules  of  eligibility  require  that  an  applicant  be  a 
premedical  student  of  at  least  three  years  college 
standing  . . . that  he  take  a medical  college  ad- 
missions test,  and  that  his  college  grade  transcript 
be  submitted  with  the  completed  application  form. 
Illinois  residency  is  not  required. 

The  board  of  the  Medical  Student  Loan  Fund 
Program  conducts  its  annual  interview  in  January 
for  those  students  who  wish  to  enter  medical 
school  the  following  September.  Those  approved 
for  assistance  are  accepted  on  a comparative  and 
competitive  basis.  Information  and  applications 
may  be  obtained  from  Roy  E.  Will,  secretary. 
Joint  Medical  Student  Loan  Fund  Board,  Illinois 
Agricultural  Association,  1701  Towanda  Ave.,  P.O. 
Box  901,  Bloomington. 


IMPARTIAL  MEDICAL  TESTIMONY 


The  Impartial  Medical  Testimony  program,  in 
which  the  Illinois  State  Medical  Society  partici- 
pates, is  designed  to  elicit  objective  medical  truth 
and  facilitate  the  equitable  disposition  of  injury 


cases  in  the  courts  of  Illinois. 

As  a technique  of  judicial  administration,  im- 
partial medical  testimony  examiners  are  ordered 


386 


Illinois  Medical  Journal 


by  the  court  when  there  is  evidence  of  a wide  di- 
vergencer'bf  medical  opinion  in  the  injury  which 
is  subject  to  litigation.  The'  introduction  of  the 
IMT  examiner  and  subsequent  examination  of 
injuries  provide  the  court*  with  objective,  impar- 
tial medical  data  for  use  in  pre-trial  conferences 
and  in  jury  trials. 

Authorization  for  the  use  of  IMT  examiners  was 
established  by  the  introduction  of  Illinois  Supreme 
Court  Rule  17-2  in  September,  1961. 

Illinois  is  distinquished  in  this  matter  by  being 
the  only  state  which  has  a court  rule  permitting 
the  state-wide  use  of  impartial  medical  testimony. 
The  Illinois  State  Medical  Society  played  a sig- 
nificant role  in  the  creation  and  development  of 
the  IMT  program.  Impartial  medical  testimony  in 


other  states  is  limited  to  certain  jurisdictions  with- 
in the  states. 

The  Illinois  State  Medical  Society  panel  of 
impartial  medical  examiners  is  comprised  of  ap- 
proximately 250  physicians  who  are  grouped  into 
some  20  medical  specialties.  Composition  of  the 
panel  is  reviewed  annually  to  maintain  the  high- 
est standards  for  the  courts  of  Illinois. 

The  Illinois  State  Medical  Society  is  apprecia- 
tive of  its  role  in  offering,  in  conjunction  with 
the  Supreme  Court,  impartial  medical  service  for 
the  courts  of  Illinois.  The  IMT  Committee  of 
the  state  society  is  charged  with  the  responsibility 
of  maintaining  the  IMT  panel  of  qualified  physi- 
cians, as  required  by  the  court. 


INSURANCE 

Retirement  Investment  Program 

The  Board  of  Trustees  of  the  Illinois  State 
Medical  Society  has  approved  the  Retirement 
Investment  Program  which  makes  available  to 
members  a means  of  providing  for  retirement 
with  group  advantages  an  individual  physician 
could  not  otherwise  obtain.  The  group  annuity 
and  mutual  fund  portion  of  the  program  may 
also  be  used  as  funding  vehicles  for  Keogh  quali- 
fied investment  if  so  desired.  The  Tax  Qualified 
Retirement  Program  (Keogh)  and  the  Retirement 
Investment  Program  permit  balanced  Investments 
to  counter  economic  fluctuations. 

Annuities  or  mutual  funds  alone  do  not  meet 
the  problems  of  recession  and  inflation,  but  to- 
gether they  do  permit  a sound  retirement  plan. 

The  group  annuity  provides  a guaranteed  life- 
time income  at  retirement,  serving  as  a hedge 
against  periods  of  recession  or  declining  prices, 
while  the  mutual  fund  provides  an  opportunity 
for  common  stock  investment  serving  as  a hedge 
against  periods  of  inflation  or  rising  prices. 

A member  physician  wishing  this  type  of 
retirement  protection  may  obtain  it  through  the 
Illinois  State  Medical  Society.  By  doing,  so  he  not 
only  receives  advantages  he  would  not  otherwise 
have,  but  he  is  able  to  benefit  from  the  collective 
opinions  and  research  facilities  of  the  insurance 
company  and  the  mutual  fund’s  investment  ad- 
visor. 

The  Retirement  Investment  Program,  making 
available  the  group  annuity  at  a substantial  re- 
duction in  premium,  and  the  mutual  funds,  offered 
without  sales  commission  load,  is  one  of  the  most 
recent  of  its  kind  and  was  developed  after  several 
years  of  study  taking  into  consideration  other 
group  plans  and  retirement  alternatives. 

The  size  of  the  retirement  contribution,  the  pro- 
portion of  investment  between  the  group  annuity 
and  the  mutual  fund,  and  the  retirement  age  are 
determined  by  the  participating  physician. 

The  Continental  Illinois  National  Bank  and 
Trust  Co.  of  Chicago  receives  all  physicians’ 
contributions,  and  maintains  records. 


PROGRAMS 

4. 

Croup  Annuity 

The  group  annuity,  underwritten  by  the  Conti- 
nental Assurance  Co.,  participates  in  dividends 
which  are  reinvested  annually  at  compound  inter- 
est. 

The  group  annuity  may  provide  an  insurance 
death  benefit  and  a total  and  permanent  dis- 
ability guarantee.  In  the  event  of  death  prior  to 
retirement,  a member’s  beneficiary  would  receive 
the  death  benefit  or  the  cash  value  of  the  annuity, 
whichever  is  greater. 

Six  options  for  settlement  at  retirement  are 
available  under  the  annuity.  The  most  frequently 
chosen  is  the  life  income  option  which  guar- 
antees a base  income  for  life  that  can  never  be 
outlived.  With  the  increase  of  life  expectancy,  there 
is  a danger  of  depleting  capital  during  advanced 
years.  However,  the  group  annuity  assures,  at 
least,  a base  or  fixed  income  which  cannot  be 
outlived.  Of  equal  importance  is  the  fact  that 
settlement  may  be  arranged  under  the  group 
annuity  to  guarantee  at  least  a return  of  the 
member’s  investment  to  his  beneficiary  if  he 
elects  a life  income  and  dies  shortly  after  re- 
tirement. 

Mutnal  Fund 

The  no  load  open  end  mutual  fund,  consist- 
ing primarily  of  common  stocks,  is  managed  by 
Stein  Roe  & Farnham  of  Chicago,  which  has 
been  serving  as  investment  adviser  to  pension 
and  profit  sharing  trusts,  trustees,  individuals, 
and  other  investors  since  1932. 

The  Stein  Roe  & Farnham  Stock  Fund  is 
quoted  daily  in  most  major  newspapers  and  the 
Wall  Street  Journal.  The  fund  has  no  sales  com- 
missions. The  investment  adviser  receives  a quar- 
terly management  fee  of  V»  of  1 per  cent  of  the 
average  net  asset  value  of  the  fund.  Management 
fees  are  common  to  all  mutual  funds  and  are 
distinct  from  sales  loads. 


1 


/or  October,  1970 


387 


I INIVFRS^ITY  OF  MARYLAND 


Group  Disability  Program 

The  Illinois  State  Medical  Society’s  officially 
approved  Group  Disability  Program  is  available 
to  all  eligible  members  of  ISMS  up  to  age  70 
who  are  regularly  attending  all  of  the  usual 
duties  of  their  occupation.  Three  different  types 
of  coverage  are  available  under  the  program, 
with  an  over-70  conversion  privilege. 

Benefits  of  the  program  are  payable  regardless 
of  any  other  insurance  and  no  restrictive  riders 
may  be  attached  after  issuance.  The  master  con- 
tract contains  a special  renewal  condition  where- 
by the  individual  coverage  cannot  be  terminated. 

Provision  has  been  made  for  an  adjudication 
committee  to  advise  the  carrier  on  claims  and 
other  administrative  problems.  The  adjudication 
committee  will  review  the  medical  data  and  make 
recommendations  regarding  coverage  which  the  in- 
surance company  might  otherwise  reject. 

The  program  is  explained  in  detail  in  a bro- 
chure which  is  available  by  writing  to  Parker, 
Aleshire  & Co.,  9933  Lawler  Ave.,  Skokie  60076. 

Group  Major  Medical  Expense  Plan 

A $25,000  Group  Major  Medical  Expense 
Plan  designed  for  the  Illinois  State  Medical  So- 
ciety has  a 20%  co-insurance  feature  and  a $500 
or  $1,000  deductible,  whichever  the  physician  se- 
lects. For  hospital  room  and  board,  the  Plan  will 
pay  up  to  $50  a day  and  in  addition  up  to  $45  a 
day  in  an  intensive  care  unit.  It  will  pay  $20  a 
day  in  a convalescent  home  following  release 
from  a hospital  up  to  90  days.  The  Plan  also  pro- 
vides maximum  coverage  for  the  insured  in  the 
event  of  mental  illness  and  up  to  $2,000  for  de- 
pendents. It  will  also  cover  a congenital  anomaly 
from  the  first  day  of  birth  after  the  effective  date 
of  the  contract  up  to  $2,000. 

New  members  joining  the  Society  will  be  al- 
lowed to  enroll  without  evidence  of  insurability  or 
a health  statement  under  age  40  within  six  months 
after  notification  of  the  Plan’s  availability. 

The  Group  Major  Medical  Expense  Plan  is  out- 
standing and  will  provide  members  with  protec- 
tion against  catastrophic  illness. 

The  Plan  is  underwritten  by  the  Commercial 
Insurance  Co.  of  Newark,  N.J.,  and  is  administered 
by  Parker,  Aleshire  & Co.,  Skokie  60076.  Addi- 


tional information  may  be  obtained  from  the  Illi- 
nois State  Medical  Society. 

Tax-Qualified  Retirement  Program 

As  mentioned  above,  the  Board  of  Trustees 
has  also  approved  the  Society’s  Tax-Qualified  Re- 
tirement Program,  which  utilizes  a Continental 
Assurance  Company  Group  Annuity  and  the  Stein 
Roe  & Farnham  Stock  Fund.  This  Program  is 
intended  for  members  who  may  find  the  pro- 
visions of  the  Keogh  Act  to  their  advantage.  A 
recent  liberalization,  effective  in  1968,  which  will 
allow  contributions  made  by  self-employed  phy- 
sicians to  be  fully  deductible  is  expected  to  make 
this  Program  more  attractive  to  the  membership. 
The  principal  provisions  of  the  Keogh  Act  are  as 
follows: 

1.  A self-employed  physician  may  set  aside  10% 
of  his  net  income  from  the  practice  of  medi- 
cine or  $2,500.00  whichever  is  the  lesser, 
each  year  for  his  own  retirement. 

2.  A self-employed  physician  may  deduct  all  of 
this  amount  from  his  income  tax. 

3.  A self-employed  physician  must  include  all 
full-time  employees  with  three  or  more 
years  service  under  the  Plan.  A full-time 
employee  is  defined  as  an  employee  work- 
ing twenty  hours  or  more  a week  for  a 
period  of  five  or  more  months.  The  em- 
ployee’s contributions  are  made  by  the  phy- 
sician as  a percent  of  salary  at  least  equal 
to  that  percentage  of  net  income  put  aside 
by  the  physician  for  his  own  retirement. 

4.  Funds  invested  under  the  Tax-Qualified  Re- 
tirement Program  accumulate  tax  free  until 
distribution. 

Continental  Illinois  National  Bank  & Trust 
Company  of  Chicago  acts  as  Trustee  for  the 
Program’s  Annuity  and  Stock  Fund  shares  and 
receives  all  physicians’  contributions  and  main- 
tains the  Program’s  records. 

Members  wishing  additional  information  on 
the  Retirement  Investment  Program  or  its  Keogh 
Act  Program  and  the  Tax-Qualified  Retirement 
Program  should  write  the  Administrator  for  par- 
ticulars: Paul  H.  Robinson,  Jr.,  Incorporated,  Ad- 
ministrator, ISMS  Retirement  Programs,  141  W. 
Jackson  Blvd.,  Chicago  60604. 


Professional  Liability  Program 


An  ISMS-Sponsored  Malpractice  Liability  In- 
surance Program  became  available  to  members 
after  it  was  approved  by  the  Board  of  Trustees 
and  the  State  of  Illinois  Insurance  Department. 
All  members  may  enroll  in  it  at  any  time. 

The  Program  was  devised  as  an  answer  to 
the  physician’s  complaints  of  arbitrary  policy 
cancellations  due  to  high  risk  specialty,  age, 
abrupt  increases  in  premium  rates  and  headlong 
out  of  court  settlements. 


The  underwriter  of  the  program  is  Employers’ 
Group  of  Insurance  Companies,  an  83  year  old 
Boston  firm.  The  administrator  is  Parker,  Ale- 
Shire  & Company,  Skokie,  which  has  served  ISMS 
on  other  insurance  plans  since  1946. 

Here  are  some  key  features  of  the  program: 

1.  Coverage  is  available  regardless  of  age,  area 
in  state  in  which  member  practices,  or  specialty. 

2.  ISMS  directly  supervises  and  controls  the 
program,  in  conjunction  with  the  administra- 


388 


Illinois  Medical  Journal 


tor  and  underwriter.  No  policy  will  be  declined 
or  cancelled  without  just  cause  and  a review 
by  an  ISMS  designee.  Any  proposals  for  pre- 
mium rate  increases  or  other  changes  will  be 
submitted  to  the  Insurance  Committee  for  re- 
view and  acceptance.  Firm  steps  are  being 
taken  to  improve  the  legal  climate  in  Illinois.  No 
claims  will  be  settled  without  the  written  ap- 
proval of  the  insured.  Outstanding  defense 
counsels,  expert  in  malpractice  cases,  have  been 
retained.  The  legal  profession  has  been  noti- 
filed  that  every  nuisance  claim  will  be  fought. 
An  educational  program  emphasizes  claim  pre- 


vention techniques  and  informs  members  of 
malpractice  trends. 

3.  Coverage  up  to  $1,000,000  is  available. 

4.  Premium  rates  are  in  line  with  those 
charged  by  other  insurers.  A unique  premium 
saving  feature  makes  the  plan  especially  attrac- 
tive to  the  member  engaged  in  corporate  prac- 
tice. A better  legal  climate  will  help  stabilize 
the  rates  because  rates  will  reflect  the  loss  ex- 
perience as  it  occurs  in  Illinois. 

Full  details  and  application  forms  may  be  ob- 
tained from  Parker,  Aleshire  & Company,  9933 
North  Lawler  Avenue,  Skokie,  Illinois  60076  or 
by  calling  312-679-1000. 


RADIO-TV  PUBLIC  SERVICE  MATERIALS 


Radio  materials  available  from  the  Illinois  State 
Medical  Society  include: 

1)  “Today’s  Health  Tip” — a new  30-second 
health  message  every  day.  Available  on 
records  (30  messages  per  record)  which  fea- 
ture the  voice  of  Dr.  “SIMS.”  For  added 
local  appeal  scripts  are  also  available  which 
can  be  read  by  local  announcer  or  physician. 

2)  “Medicine,  Morals  and  You” — an  11-part, 
half  hour  series  combining  a pre-taped 
dramatic  introduction  and  live  interviews 
with  physicians  and  clergymen  who  discuss 
such  vital  medical-moral  issues  as:  abor- 
tion, narcotics  addiction,  contraceptive  pills, 
suicide,  and  the  unwed  mother. 

Television  materials  currently  include  one-minute 
animated  spots  on  the  subjects  of  measles,  ar- 
thritis quackery,  pre-school  examinations,  and 
rheumatic  fever.  Subsequent  spots  stressing  pre- 
ventive medicine  will  be  produced  during  the 
course  of  the  year. 

In  addition,  the  Division  of  Public  Relations 
maintains  a radio  and  television  speakers’  bureau, 
which  obtains  physician-speakers  for  radio  and 
television  interview  shows  on  request. 

Doctor's  Responsibility  to  the  Press 

Physicians  and  the  press  are  partners  in  provid- 
ing a line  of  communication  between  the  medical 
profession  and  the  public.  But,  the  press  cannot 
carry  out  its  traditional  responsibility  in  inform- 
ing the  public  in  the  area  of  medical  and  patient 
news  without  the  cooperation  of  the  medical  so- 
ciety and  individual  doctors.  The  Inevitable  penal- 
ty of  silence  by  the  doctors  is  public  ignorance, 
misunderstanding  and  fear.  In  a democracy,  pub- 
lic ignorance,  misunderstanding  and  fear  can  be 
dangerous  to  professional  freedom. 

The  following  outline — based  on  a press  code 
adopted  by  the  Macon  County  Medical  Society — 
is  suggested  as  a pilot  guide  for  individual  phy- 
sicians and  county  societies  in  Illinois. 


Availability 

1)  The  officers,  committee  chairmen  or  desig- 
nated spokesmen  of  county  medical  societies  shall 
be  available  at  all  times  to  mass  media  personnel 
to  provide  authentic  information  on  medical  sub- 
jects. 

2)  A list  of  current  spokesmen  shall  be  sup- 
plied by  county  societies  to  the  executives  of  every 
newspaper,  radio  and  television  station  in  the 
county. 

3)  These  spokesmen  may  be  quoted  by  name. 
They  should  not  be  considered  by  their  colleagues 
as  self-seeking,  since  authoritative  attribution  is 
done  in  the  best  interests  of  the  public  and  the 
profession.  (In  addition,  physicians  are  private 
citizens  and  as  such  are  the  subjects  of  news 
stories  in  their  social  and  civic  activities  just  like 
any  other  citizen.) 

Physician  News 

Physicians,  as  scientists,  are  encouraged  to  give 
newspaper  interviews  and  appear  on  radio  and 
television  programs  on  medical  subjects.  Physi- 
cians may  report  on  new  or  unusual  diseases  or 
treatments  within  an  ethical  framework.  In  these 
instances,  they  should,  whenever  possible,  notify 
their  county  society  publicity  chairman  or  the  Il- 
linois State  Medical  Society. 

Physicians  may  be  asked  to  comment  as  indi- 
viduals on  politically  controversial  subjects  (such 
as  socialized  medicine).  In  this  event,  the  physi- 
cian should  clearly  indicate  that  he  is  expressing 
his  personal  viewpoint  which  should  not  be  con- 
strued as  a statement  of  medical  society  policy. 

A medical  society  officer,  however,  should  re- 
member that  any  comment  he  makes — whether  or 
not  intended  as  personal  viewpoint — is  generally 
accepted  as  official  policy. 

Patient  News 

As  the  patient’s  personal  physician,  the  doctor 
has  an  obligation  to  respect  confidences  that  come 
to  him  in  the  performance  of  his  duty  and  may 


for  October,  1970 


389 


not  release  news  except  with  the  patient’s  consent 
or  those  authorized  to  speak  for  him.  When  the 
press  learns  of  the  illness  of  private  patients  from 
other  sources,  the  physician  may  cooperate  with 
the  press  in  answering  any  inquiries  in  the  in- 
terest of  accuracy  and  to  avoid  embarrassment. 

When  news  of  patients  is  of  such  a nature  that 
it  automatically  falls  in  the  public  domain,  physi- 
cians should  feel  free  to  release  information  with- 
in the  framework  of  this  code. 

Patient  information  may  be  given  where  the 
nature  of  injuries,  illness  or  treatment  is  of  spe- 
cial interest.  The  report  of  such  information  shall 
be  more  in  the  nature  of  scientific  information, 
rather  than  an  expose  of  an  individual  affliction. 

Pre-Retirement  TV  and  Film  Series 

Recognizing  the  current  “retirement  revolution” 


in  which  persons  are  retiring  earlier  and  living 
longer,  the  ISMS  Committee  on  Aging  recently 
produced  a 13-part,  half  hour  weekly  television 
series  on  pre-retirement  planning  entitled,  “The 
Time  Of  Your  Life.” 

The  series — co-sponsored  through  a grant  from 
Blue  Shield  Plan  of  Illinois  Medical  Service- 
features  broadcast  personality  Norman  Ross  who 
interviews  guest  authorities  on  such  vital  topics 
as:  financial  and  estate  planning;  meeting  medical 
expenses;  where  to  live  in  retirement;  how  to 
cope  with  physical  and  emotional  problems;  and 
constructive  utilization  of  leisure  time.  Initially 
shown  on  Chicago  television,  the  series  is  now 
available  for  loan  on  16  mm.  film  to  industries, 
businesses,  and  other  organizations  throughout 
the  state  and  nation  as  a “ready  made”  course 
of  instruction. 


Illinois  Medical  Political 
Action  Committee 
(IMPAC) 


The  Illinois  Medical  Political  Action  Commit- 
tee (IMPAC)  is  a voluntary,  non-profit,  unin- 
corporated, permanent  membership  organization 
founded  in  1960.  IMPAC  serves  as  the  unified  po- 
litical action  arm  of  Illinois  physicians  and  their 
wives.  It  cooperates  with  others  in  the  healing 
arts  professions.  Funds  collected  through  IMPAC 
memberships,  used  in  support  of  candidates,  are 
administered  independently  of  other  professional 
groups.  However,  the  program  is  operated  in 
harmony  with  the  legislative  objectives  of  the 
Illinois  State  Medical  Society.  Individual  partici- 
pation in  IMPAC  is  one  means  by  which  the 
individual  physician  and  his  wife  can  effectively 
participate  in  public  affairs. 

IMPAC  participates  primarily  in  election  con- 
tests for  legislative  offices — both  those  in  the 
Illinois  General  Assembly  and  in  the  U.  S.  Con- 


gress. It  cooperates,  both  in  election  efforts  and 
in  membership  solicitation  activities,  with  the 
American  Medical  Political  Action  Committee 
(AMPAC),  its  counterpart  on  the  national  level. 

IMPAC’s  organization  consists  of  a chairman, 
an  executive  committee,  and  a council.  Political 
action  activities  are  implemented  by  local  physi- 
cian support  committees  formed  on  behalf  of  can- 
didates in  U.  S.  Congressional  or  other  legislative 
districts.  Candidate  selection  and  support  are  de- 
termined on  the  basis  of  evaluations  and  recom- 
mendations submitted  to  the  council  and  ex- 
ecutive committee  by  the  local  committees,  thus 
assuring  members  of  a “grass  roots”  voice  in 
IMPAC  activities. 

Additional  information  about  IMPAC  may  be 
obtained  by  writing:  IMPAC,  Suite  2010,  360  N. 
Michigan  Ave.,  Chicago  60601. 


Woman’s  Auxiliary 

To  The  Illinois  State  MefJical  Society 


The  new  auxiliary  year  could  not  have  begun  on  a 
higher  note  than  with  the  enthusiasm  and  fellowship 
exhibited  here  over  the  past  few  days. 

On  behalf  of  the  newly  elected  officers  may  I say  that 
we  are  delighted,  honored  and  sincerely  grateful  for  the 
confidence  you  have  placed  in  our  ability  to  carry  out 
the  work  of  the  Women’s  Auxiliary  to  the  Illinois  State 
Medical  Society  during  the  coming  year.  However,  we 


are  well  aware  that  shoulder  to  shoulder  with  honor 
always  walks  responsibility. 

Like  happiness,  success  is  one  of  the  fundamental  goals 
of  all  people,  and,  of  course,  we  want  success  for  this 
administration’s  goals  just  as  has  been  true  of  all  pre- 
vious ones. 

To  carry  through  your  expectations,  we  must  have 
the  cooperation  and  assistance  of  not  only  each  District 


390 


Illinois  Medical  Journal 


and  each  County  auxiliary,  but  also  that  of  each  indi- 
vidual member.  In  the  final  analysis,  it  is  the  individual 
memiter  who  is  the  power  behind  the  Auxiliary. 

To  uphold  the  proud  heritage  of  the  AMA  Woman’s 
.Auxiliary,  we,  in  Illinois,  must  maintain  ourselves  as  a 
first  rate  organization.  In  the  year  ahead,  we  hope  to 
see  countv  auxiliaries  throughout  the  State  develop  to 
their  highest  possible  strength  and  efficiency  so  they  may 
be  able  to  accomplish  the  greatest  amount  of  good. 

It  seems  that  we  could  be  motivated  by  no  wiser  phi- 
losophy than  was  expressed  by  the  prophets  of  old  who 
believed  that  we  cannot  pass  along  to  others  the  account- 
ability for  situations  and  conditions  in  our  homes  or 
communities.  We  must  face  up  to  these— bear  the  burdens 
and  do  what  we  can  to  resolve  them. 

This,  too,  is  the  essence  of  the  theme  your  president 
has  selected  for  Illinois  in  1970-71.  Our  State  theme  will 
stress  the  importance  of  the  ‘‘Fourth  ‘R’  RESPONST 
BII.ITY  with  special  emphasis  on  INDIVIDU.AL  RE- 
SPONSIBILITY. 

It  wasn’t  “the  three  Rs”  that  made  this  country  the 
greatest  in  the  world. 

George  Washington's  schooling  would  not  have  admit 
ted  him  to  the  LTniversity  of  Illinois. 

Benjamin  Eranklin’s  formal  education  did  not  go  be- 
yond two  years. 

James  Madison  and  Alexander  Hamilton  were  officers 
fighting  in  the  Revolutionary  War  at  an  age  when  the 
youth  of  today  are  packing  their  bags  getting  ready 
to  go  away  to  college. 

But  what  these  men  did  have  was  a thorough  ground- 
ing in  that  all  important  “Eourth  ‘R’  ’’—Responsibility! 

As  individuals  we  have  the  responsibility  to  think  and 
act  wisely  today  so  that  tomorrow  will  be  a better  dav. 
We  are  told  there  are  two  ways  to  approach  a respon- 
sibility . . . with  reluctance  or  with  enthusiasm. 

A famous  writer  once  said,  “Every  tomorrow  has  two 
handles.  You  can  take  hold  of  tomorrow  with  the  handle 
of  Anxiety  or  you  can  take  hold  of  it  wdth  the  handle 
of  Eaith.” 

Concerned  about  the  moral  climate  of  our  nation, 
county  auxiliaries  in  Illinois  towns,  rural  areas  and  cities 
demonstrated  in  yesterday’s  annual  reports  that  they  had 
indeed  taken  hold  of  the  handle  of  Faith. 

Their  many  voices  told  how  positive  thinking  and 
determined  action  had  resulted  in  effective  health-educa- 
tion programs.  Their  voices  spoke  eloquently  of  projects 
that  have  gained  |1 1,000  for  AMA-ERF,  an  all  time 
high  for  Illinois. 

That  Miracles  can  be  performed  by  mobilizing  Woman 
Power  is  illustrated  in  the  story  concerning  a county 
auxiliary  president  who  died  suddenly  and  there  was 
no  room  for  her  in  Heaven  ...  so  she  was  sent  to  the 
regions  below.  Two  days  later  Satan  called  up  and  asked 
that  she  be  removed  immediately!  “What’s  wrong?” 
asked  St.  Peter.  She  seemed  to  be  a very  nice  lady.  I’ll 
tell  vou  what’s  wrong  stormed  Satan,”  She  has  organized 
a group  of  women  down  here  and  they  have  raised  enough 
money  to  install  air  conditioning!” 


In  charting  the  course  for  the  year  ahead,  Mrs.  R.  C. 
L.  Robertson,  national  president-elect,  stated  in  her  ad- 
dress yesterday  that  the  following  guide  lines  have  been 
established: 

1.  .AMA-ERF  and  Health  Man-Power  are  to  be  con- 
sidered Top  Priority  Projects. 

2.  Physical  Fitness  of  Doctors’  families  (as  well  as  the 
public)  will  be  highlighted. 

3.  Strongly  encouraged  are  Health  Education  Programs 
concerning  Drug  Abuse,  Alcoholism  or  any  one  of 
the  eleven  Package  Programs  which  are  ready  and 
waiting  your  consideration. 

AVe  cannot  afford  to  overlook  our  Responsibility  of 
taking  a part  in  helping  to  care  for  the  aged  and  the 
handicapped.  The  Home-Care  Project,  one  of  the  most 
vital  of  auxiliat^  services  may  be  compared  to  the  par- 
able of  “The  Most  Precious  Gem.”  The  parable  tells  of 
a man  who  could  not  enter  the  Pearly  Gates  except  that 
he  bring  earth’s  most  precious  possession  ...  so  he 
searched  the  earth  trying.  Eirst,  Gold  as  a symbol  of 
AVealth:  then.  The  Sword  of  Alexander  The  Great  as 
a symbol  of  Conquest;  next.  The  Books  of  Solomon  as 
a symbol  of  AAbsdom.  .All  were  turned  down  by  the 
Guardian  Angel.  Again  the  man  returned  to  earth  . . . 
finding  nothing  he  resolved  to  return  and  confess  his 
failure  to  the  Guardian  .Angel.  On  the  way  he  befriended 
a poor,  broken  beggar  and  when  he  reached  the  Pearly 
Gates  his  cheeks  were  marked  with  tears  of  sympathy. 
“A’ou  have  brought  it!”  cried  the  Guardian  Angel.  You 
have  brought  Earth’s  most  precious  thing,  “The  Priceless 
Pearl  of  Compassion.” 

In  working  together  as  responsible  adults,  let  us  strive 
for  excellence  in  the  promotion  of  health  education  in 
our  communities.  Best  of  all  let  us  develop  a team  spirit 

. . for  auxiliary  work  is  tridv  the  finest  type  of  part- 
nership. In  this  togetherness  lies  our  power  of  achieve- 
ment. 

Perhaps  vou  may  recall  this  occurrence  which  took 
place  in  the  Olympic  Games  a number  of  years  ago. 
The  Erench  Team  started  well  in  the  relay  race  and 
was  in  the  lead  when  one  of  the  runners  dropped  the 
baton  as  it  was  being  passed  to  him  by  a teammate. 
This  put  the  Erench  team  out  of  the  running  and  lost 
the  race  for  them.  The  player  responsible  sank  to  the 
ground  and  wept  openlv.  Those  who  watched  under- 
stood his  despair  when  so  many  others  were  affected 
by  his  failure.  His  country’s  high  hopes  for  victory  had 
been  lost.  The  training  and  efforts  of  those  who  had  run 
before  him  were  nullified.  AVorst  of  all  the  runner  that 
was  to  follow  did  not  even  get  a chance  to  run. 

Today,  we  stand  on  the  threshold  of  a new  auxiliary 
year.  The  baton  is  now  being  passed  to  this  administra- 
tion. AA^ith  the  willing  hands  of  Illinois’  approximately 
three  thousand  members,  we  cannot  fail  to  carry  it 
through  to  the  successful  accomplishment  of  our  goals. 

Mrs.  AVilson  H,  AA^est 
President 


OFFICERS 


PRESIDENT:  Mrs.  AVilson  H.  AVest, 

14  Oakwood  Drive.  Belleville  62223 
PRESIDENT-ELECT:  Mrs.  David  Kweder 
1432  N.  Sheridan  Rd.,  AVaukegan  60085 
AdCE-PRESIDENT:  Mrs.  Robert^  Hartman 
1040  AV.  College,  Jacksonville  62650 
VICE-PRESIDENT:  Mrs.  August  Martinucci 
1210  Mason,  Joliet  60435 


A^ICE-PRESIDENT:  Mrs.  Joseph  A.  Cari 
9212  S.  Mozart,  Evergreen  Park  60642 
RECORDING  SECRETARY:  Mrs.  Thomas  Tourlentes 
State  Research  Hospital,  Galesburg  61401 
CORRESPONDING  SECRETARY:  Mrs.  Edtvard  Szewezyk 
1 Kilmar  AVoods,  Belleville  62224 
TRE.ASLTRER:  Mrs.  Gaetano  Buttice 
266  Stonegate  Rd.,  Clarendon  Hills  60514 


for  October,  1970 


391 


I ii\Ji\/FR!^ITY  OF  MARYLAND 


DIRECTORS 


Mrs.  Sherman  Arnold 
2416  Brookwood  Drive,  Flossmoor  60422 
Mrs.  Howard  Lowy 

112  Pekin  Ave.,  East  Peoria  61611 
Mrs.  Lewis  A.  Hare 

10811  S.  Fairfield  Ave.,  Chicago  60655 


DISTRICT  COUNCILORS 


1.  Boone,  DeKalb,  Jo  Daviess,  Kane,  Lake,  Stephenson, 
Winnebago. 

Mrs.  Norm  Hagman 
5059  Crofton,  Rockford 

2.  Bureau,  LaSalle,  Lee,  Livingston,  Whiteside 

Mrs.  W.  A.  McNichols,  Jr. 

912  Myrtle  Avenue,  Dixon  61020 

3.  Cook 

Mrs.  Harold  Dubner 

910  Private  Rd.,  Winnetka  60093 

Mrs.  Jan  J.  Kukral 

860  N.  Lake  Shore  Dr.,  Chicago  60611 

Mrs.  John  Van  Prohaska 

5830  Stony  Island,  Chicago  60637 

4.  Knox,  Mercer,  Peoria,  Rock  Island,  Warren 

Mrs.  James  Miller 

1218-21st  Ave.,  Rock  Island  61201 

5.  Logan,  McLean,  Sangamon,  Tazewell 

Mrs.  Frank  Torrey 

1331  Center  St.,  Pekin  61554 


6.  .Adams,  Madison,  Morgan-Scott 

Mrs.  Ralph  F.  Davis 
2639  Vermont,  Quincy  62301 

7.  Christian,  Effingham,  Macon,  Marion-Clinton 

Mrs.  Wilmer  Talbert 

316  North  Summit,  Decatur  62522 

8.  Champaign,  Crawford,  Vermillion 

Mrs.  Warren  R.  Freeman 
1202  Belmead,  Champaign  61820 

9.  Jefferson-Hamilton 

Mrs.  Cyril  Anslinger 
26  Northbrook,  Mt.  Vernon  62864 

10.  St.  Clair,  St.  Clair-Belleville  Branch,  Jackson 

Mrs.  C.  B.  Boeshart 
42  Magnolia  Dr.,  Belleville  62221 

11.  DuPage,  Kankakee,  Will-Grundy 

Mrs.  James  Ryan 

Woodlea  Road  Box  14,  Kankakee  60901 


CHAIRMEN  OF  COMMITTEES 


AMA-ERF  Mrs.  William  T.  Hodges 

1000  S.  Wildwood  Ave.,  Kankakee  60901 

Archives  Mrs.  Walter  Olsewski 

9216  S.  Mozart,  Evergreen  Park  60642 

Benevolence  Mrs.  Lloyd  Teter 

335  Country  Club  Dr.,  Pekin  61554 

Community  Health  Mrs.  Robert  Hartman 

1040  W.  College,  Jacksonville  62650 

Convention  Mrs.  Mitchell  Spellberg 

1212  N.  Lake  Shore  Dr.,  Chicago  60610 

Vice  Chairman  Mrs.  Eugene  Vickery 

602  Oak  Street,  Lena  61048 

Credentials  & Regis Mrs.  John  Ovitz 

427  S.  Maine,  Sycamore  60178 

Editorial  (Pulse)  Mrs.  Wendell  Roller 

309  S.  Main,  Box  664,  Monmouth  61462 

Assistant  Editorial  (Pulse)  Mrs.  Eugene  Vickery 

602  Oak  Street,  Lena  61048 

Finance  Mrs.  Paul  Palmer 

1511  Bigelow,  Peoria  61604 

Health  Careers  Mrs.  Thomas  Clatter 

2407  Spring  Brook  Ave.,  Rockford  61107 

Home  Centered  Health  Care  Mrs.  Maurice  Woll 

159  S.  9th  Street,  East  Alton  62024 

Hospitality  Mrs.  John  Koenig 

2518  Oakwood  Dr.,  Olympia  Fields  60461 

Vice  Chairman  Mrs.  Maurice  Goldstein 

6853  North  Hiawatha,  Chicago  60646 


Vice  Chairman  Mrs.  C.  R.  Heidenreich 

20313  Kedzie,  Olympia  Fields  60461 

International  Health  Mrs.  R.  S.  Hoover 

1752  Highland  Drive,  Freeport  61032 

Legislation  Mrs.  Alan  Taylor 

1607  N.  Vermilion,  Danville  61832 

Mcmbers-at-Large  Mrs.  O.  E.  Barbour 

4119  Hollyridge  Cr.,  Peoria  61614 

Mental  Health  Mrs.  Michael  J.  Parent! 

1039  Lathrop,  River  Forest  60305 

Organization  Mrs.  David  Kweder 

1432  N.  Sheridan  Rd.,  Waukegan  60085 

Press  & Publicity  Mrs.  Leslie  Lindeen 

801  Stevens  Ave.,  Sycamore  60178 

Program  Mrs.  Joseph  A.  Cari 

9212  S.  Mozart.  Evergreen  Park  60642 

Public  Affairs  Mrs.  J.  J.  Failor 

9 Litchfield  Lane,  Champaign  61820 

Vice  Chairman  Mrs.  Harry  Parks 

25  High  Forest,  Belleville  62221 

Revisions  and  Resolutions  Mrs.  Joseph  Shanks 

3121  Sheridan  Rd.,  Apt,  804,  Chicago  60657 

Rural  Health  Mrs.  Bernard  Baalman 

Hardin  62047 

Safety  Mrs.  Arthur  Smith 

206  Country  Club  Lane,  Belleville  62223 

WASAMA  Mrs.  G.  F.  Tufo 

750  West  Hutchinson,  Chicago  60613 


392 


Illinois  Medical  Journal 


AD  HOC  COMMITTEES 

Children  & Youth  Chairman  Mrs.  Alton  Morris 

10  Connecticut  Ct.,  Springfield  62704 

Vice  Chairman  Mrs.  Stanley  Burris 

1630  Wiggins,  Springfield  62704 

Religion  & Medicine  Mrs.  Sherman  Arnold 

2416  Brookwood  Drive,  Flossmoor  60422 

Parliamentarian  Mrs.  Percy  M.  Clark 

5722  Franklin  Ave.,  LaGrange  60525 


Illinois  Medical  Assistants  Association 


The  Illinois  Medical  Assistants  Association  is 
just  what  the  name  implies — an  association  of 
medical  assistants  throughout  the  State  of  Illi- 
nois who  have  become  an  educational  organ- 
ization with  objectives  as  follows:  (a)  To  bring 
into  one  association  all  medical  assistant  or- 
ganizations of  the  State  of  Illinois;  (b)  to  pro- 
vide an  organization  for  those  residing  in  Illinois 
counties  where  no  medical  assistants  societies  are 
organized;  (c)  to  assist  the  physicians  in  im- 
proving medical  public  relations;  (d)  to  main- 
tain and  advance  the  standards  of  professional 
employment  and  to  give  honest,  loyal  and  ef- 
ficient service  to  the  medical  profession  and  the 
public;  (e)  to  meet  from  time  to  time  to  secure 
interchange  of  ideas. 

The  medical  assistant  associations  are  educa- 
tional groups — not  social.  We  are  not  a union  and 
any  attempt  to  promote  the  unionization  of  this 
society  or  its  members  automatically  forfeits  the 
membership  of  the  person  or  persons  making 
such  an  attempt. 

Now  the  qualified  medical  assistant  has  the 
opportunity  to  pass  a special  board  examination 
and  thus  become  a “Certified  Medical  Assistant.” 


This  will  affect  directly  or  indirectly  every  phy- 
sician’s office.  Of  note  is  the  fact  that  you  do 
not  have  to  belong  to  the  Association  to  take 
this  examination.  For  further  information  as  to 
qualifications  necessary  to  take  the  examination 
write  to  American  Association  of  Medical  As- 
sistants, 200  E.  Ohio  St.,  Chicago  60611. 

Local  programs  in  the  component  societies  of 
IMAA  are  geared  to  the  needs  of  that  particular 
area.  Obviously  the  strictly  specialist  areas  would 
have  entirely  different  problems  and  educational 
needs  than  the  area  of  the  general  practitioner 
where  the  office  is  staffed  by  one  or  two  medical 
assistants.  Hence  the  educational  programs  in  your 
area  would  be  decided  by  your  own  medical  as- 
sistants and  supervised  by  the  doctors  in  your 
own  county  society. 

We  need  you.  Doctor,  to  encourage  your  medi- 
cal assistants  to  join  our  association.  But  also 
you  could  help  us  by  assisting  us  in  selecting  the 
proper  educational  programs  which  in  the  long 
run  would  be  of  most  benefit  to  you.  That  is  our 
whole  purpose,  to  become  better  medical  assistants 
so  we  can  help  you  to  help  your  patients. 


for  October,  1970 


393 


Medical  and  Paramedical  Education 


MEDICAL  SCHOOLS  IN  THE  STATE  OF  ILLINOIS 


Chicago  Medical  School 
2020  W.  Ogden  Ave. 

Chicago,  Illinois  60612 
Northwestern  University  Medical  School 
303  E.  Chicago  Ave. 

Chicago,  Illinois  60611 


University  of  Chicago  Pritzker  School  of  Medicine 
950  E.  59th  Street 
Chicago,  Illinois  60637 
University  of  Illinois  College  of  Medicine 
1853  W.  Polk  Street 
P.O.  Box  6998 
Chicago,  Illinois  60680 


Stritch  School  of  Medicine— Loyola  University 
2160  S.  First  Ave. 

Maywood,  Illinois  60153 

The  following  are  medical  schools  in  Illinois  which 
are  presently  in  the  developmental  stages.  The  names  used 
are  not  necessarily  correct. 

Rush  Medical  College 
Chicago,  Illinois 

•Anticipates  enrollment  to  begin  in  1971 

Southern  Illinois  University  Medical  School 
Carirondale,  Illinois 

Anticipates  enrollment  to  begin  in  1972 


University  of  Illinois— The  Abe  Lincoln  Campus 
Peoria— Rockford.  Illinois 
Anticipates  enrollment  to  begin  in  1972 


APPROVED  SCHOOL  FOR 
MEDICAL  RECORD  LIBRARIANS 

CHICAGO— University  of  Illinois  at  the  Medical  Center 

APPROVED  SCHOOL  OF 
PHYSICAL  THERAPY 

CHICAGO— Northwestern  University  Medical  School 

APPROVED  COURSE  IN 
OCCUPATIONAL  THERAPY 

CHICAGO— University  of  Illinois-School  of  Associated 
Medical  Service 

APPROVED  SCHOOLS  OF 
INHALATION  THERAPY 

CHICAGO— Cook  County  Hospital,  Edgewater  Hospital, 
Northwestern  University  Medical  Center, 
Rush  Presbyterian-St.  Lukes  Hospital,  Uni- 
versity of  Chicago  Hospitals 
DECATUR-St.  Mary’s  Hospital 
MELROSE  PARK— Gottlieb  Memorial  Hospital 
MOLINE— Lutheran  Hospital 

SPRINGFIELD— Memorial  Hospital,  St.  John’s  Hospital 


APPROVED  SCHOOLS  OF 
CERTIFIED  LABORATORY  ASSISTANTS 

.ALTON— Alton  Memorial  Hospital 

.ARLINGTON  HEIGHTS— Northwest  Community  Hospi- 
tal 

CHIC.AGO— St.  Elizabeth  Hospital,  Swedish  Covenant  Hos- 
pital, Veterans  Administration  AVest  Side 
Hospital 

CRYSTAL  L.AKE-McHenry  County  College 

DANVILLE— St.  Elizabeth  Hospital 

DIXON— Sauk  Valley  College,  Dixon  Public  Hospital 

ELGIN— Sherman  Hospital 

O.AK  PARK— Oak  Park  Hospital 

PALOS  HILLS— Moraine  Valley  Community  College 

QUINCA’— Blessing  Hospital 

APPROVED  SCHOOLS  OF 
CYTOTECHNOLOGY 

CHIC.AGO— Michael  Reese  Medical  Center,  Mount  Sinai 
Medical  Center,  University  of  Chicago  Hos- 
pitals and  Clinics 


394 


lUinois  Medical  Journal 


APPROVED  SCHOOLS  OF 
MEDICAL  TECHNOLOGY 


AURORA— Copley  Memorial  Hospital 
BELLEVILLE-St.  Elizabeth  Hospital 
BLUE  ISLAND— St.  Francis  Hospital 
CHAMPAIGN— Burnham  City  Hospital 
CHICAGO— Aiiguslana  Hospital,  Chicago  Wesley  Memorial 
Hospital,  Edgewater  Hospital,  Grant  Hospi- 
tal of  Chicago,  Holy  Cross  Hospital,  Illinois 
Masonic  Medical  Center,  Louis  y\.  Weiss  Me- 
morial Hospital,  Mercy  Hospital,  Michael 
Reese  Hospital  and  Medical  Center,  Mount 
Sinai  Hospital  Medical  Center,  Northwestern 
University  Medical  School,  Presbyterian-St. 
Luke’s  Hospital,  St.  Anne’s  Hospital,  St.  An- 
thony’s Hospital,  St.  Joseph  Hospital,  St. 
Mary  of  Nazareth  Hospital,  University  of 
Illinois  School  of  Associated  Medical  Sciences 
and  Veterans  Administration  Research  Hos- 
pital. 

CHICAGO  HEIGHTS-St.  James  Hospital 
DANVILLE— Lake  View  Memorial  Hospital 
DECATUR— Decatur  Memorial  Hospital  and  St.  Mary’s 
Hospital 

ELK  GROVE  VILLAGE-St.  Alexius  Hospital 


EV.\NSTON— Evanston  Hospital 

St.  Francis  Hospital 

EVERGREEN  PARK-Little  Company  of  Mary  Hosi)iud 
FREEPORT— Freeport  Memorial  Hospital 
GENEV.\— Community  Hospital 
GREAT  LAKES-U.S.  Naval  Hospital 
H.VRVEY— Ingalls  Memorial  Hospital 
HINSD.XLE— Hinsdale  Sanitarium  and  Hospital 
JOLIET— Silver  Cross  Hospital 
St.  Joseph  Hospital 
M.WWOOD— Loyola  University  Center 
0.\K  L.^IVN- Christ  Commtinity  Hospital 

O. Mv  PARK— IVest  Suburban  Hospital 

P. \RK  RIDGE— Ltitheran  General  Hospital 
PEORLV— Methodist  Hospital  of  Central  Illinois  and  St. 

Francis  Hospital 
OUINC’V— St.  Mary’s  Hospital 

ROCKFORD— Rockford  Memorial  Hospital,  St.  .'\nthonv 
Hospital  and  Swedish-American  Hospital 
SPRINGFIELD— Memorial  Hospital 
St.  John’s  Hospital 
I'RB.VNA— Carle  Foundation  Hospital 
IV.VUKEGAN-St.  Therese’s  Hospital 
IVINFIELD— Central  Dupage  Hospital 


APPROVED  SCHOOLS  OF 
X-RAY  TECHNOLOGY 


ARLINGTON  HTS.— Northwest  Community  Hospital 
AUROR.4— Copley  Memorial  Flospital 
St.  Joseph  Mercy  Hospital 
BLOOMINGTON— Bloomington-Normal  Hospital 
CENTRALIA-St.  Mary’s  Hospital 
CHAMPAIGN— Burnham  City  Hospital 
CHICAGO— Chicago  Wesley  Memorial  Hospital 
Cook  County  Hospital 
Edgewater  Hospital 
Englewood  Hospital 

Franklin  Boulevard  Community  Hospital 

Henrotin  Hospital 

Illinois  Masonic  Medical  Center 

Louis  A.  IVeiss  Memorial  Hospital 

Michael  Reese  Hospital  and  Medical  Center 

Mt.  Sinai  Flospital  and  Medical  Center 

Norwegian- American  Hospital 

Provident  Hospital 

Ravenstvood  Hospital 

Roseland  Community  Hospital 

Rush-Presbyterian-St.  Luke’s  Hospital 

St.  Anne’s  Hospital 

St.  Bernard’s  Hospital 

St.  Joseph  Hospital 

St.  Mary  of  Nazareth  Hospital 

South  Chicago  Community  Hospital 

Sydney  R.  Forkosh  Memorial  Hospital 

Woodlawn  Hospital 

DANVILLE— Lake  View  Memorial  Hospital 
DECATUR— Decatur  Memorial  Hospital 
DEK.VLB— DeKalb  Public  Hospital 
DIXON— Sauk  Valley  College 

E.VST  ST.  LOUIS— Centreville  Township  Hospital 
ELGIN— St.  Joseph  Hospital 

ELMHURST— Memorial  Hospital  of  DuPage  County 


FA’,\NSFON— St.  Francis  Hospital 
Evanston  Hospital 

E\’ERGREEN  PARK-Little  Company  of  Mary  Hospital 
GALESBURG-Carl  Sandburg  College 
GLEN  ELLYN-College  of  DuPage 
(>REAT  LAKES-U.S.  Naval  Hospital 
H.ARVEY— Thorton  Commtmity  College 
HINES— Veterans  Administration  Hospital 
HINSD.VLE— Hinsdale  Sanitaritim  and  Hospital 
JOLIET— Silver  Cross  Hospital 
St.  Joseph  Flospital 
K.\NK.\KEE— St.  Mary’s  Hospital 
KEIV.ANEE— Kewanee  Public  Hospital 
MOLINE— Lutheran  Hospital 

Moline  Public  Hospital 

O. \K  P,\RK— West  Suburban  Hospital 
OLNEY— Richland  Memorial  Hospital 

P, \RK  RIDGE— Lutheran  General  Hospital 
PF.ORI.\— Methodist  Hospital  of  Central  Illinois 

St.  Francis  Hospital 
OPIINCY- Blessing  Hospital 
St.  Mary  Hospital 
RIVERGROVE-Triton  College 
ROCHELLE— Rochelle  Community  Hospital 
ROCKFORD— Rockford  Memorial  Hospital 
St.  Anthony  Hospital 
Swedish-American  Hospital 
ROCK  ISLAND— St.  Anthony’s  Hospital 
SKOKIE— Skokie  Valley  Community  Hospital 
SPRINGFIELD— Memorial  Hospital 
St.  John’s  Hospital 

SYCAMORE— Kishwaukee  Junior  College 
URB.\N.\— Carle  Memorial  Hospital 
Mercy  Hospital 


for  October,  1970 


39,5 


APPROVED  SCHOOLS  OF  NURSING 

General  Entrance  Requirements: 


Associate  Degree 
Nursing  Program 

A coeducational  nursing  program  under  the 
auspices  of  a junior  college,  two  years  in  length 
and  leading  to  an  Associate  Degree  in  Nursing. 
The  curriculum  consists  of  arts  and  sciences  at 
the  junior  college  level  and  nursing  theory  closely 
coordinated  with  nursing  practice,  under  direction 
and  supervision  of  the  college  faculty,  in  com- 
munity hospitals  and  health  facilities. 

Graduates,  both  men  and  women,  are  prepared 
to  give  patient-centered  care  in  staff  nurse  posi- 
tions in  hospitals,  nursing  homes  and  similar  situa- 
tions. They  are  prepared  to  cooperate  and  to  share 
responsibility  for  the  patient’s  welfare  with  other 
members  of  the  nursing  and  health  staff,  and  to 
develop  their  own  skills  through  experience  as 
practicing  nurses. 

BELLEVILLE 

Belleville  Area  College 

Department  of  Nursing 

2555  West  Blvd.  62221 

CHICAGO 

Amundsen-Mayfair  Junior  College 
Department  of  Nursing 
4626  N.  Knox  Ave.  60630 

Malcolm  X.  College 

Department  of  Nursing 
1757  W.  Harrison  60612 

Southeast  College  School  of  Nursing 

8600  South  Anthony  60617 

CHICAGO  HEIGHTS 

Prairie  State  College 

Department  of  Nursing 
197th  & Halsted  60411 

CHAMPAIGN 

Parkland  College  School  of  Nursing 

2 Main  Street  61820 

CICERO 

J.  Sterling  Morton  Junior  College 
Department  of  Nursing 
2423  S.  Austin  Blvd.  60650 

DIXON 

Sauk  Valley  College  School  of  Nursing 

River  Campus,  R.R.  #1  61021 

EAST  PEORIA 

Illinois  Central  College 

Department  of  Nursing 
Highview  Road, 

P.  O.  Box  2400  61611 

ELGIN 

Elgin  Community  College 
Department  of  Nursing 
373  E.  Chicago  St.  60120 

GLEN  ELLYN 

College  of  DuPage 

Department  of  Nursing 
22nd  & Lambert  Road  60137 

GRAYSLAKE 


Good  health. 

High  school  graduation:  with  courses  in  biologi- 
cal and  physical  sciences  (1-2  units  of  chem- 
istry recommended)  and  mathematics  (1-2 
units  recommended). 

Qualification  for  admission  to  the  college  and 
the  nursing  curriculum. 

Cost:  tuition  in  public  supported  junior  col- 
leges is  low,  in  private  colleges  considerably 
higher.  Add  to  this:  fees,  books,  uniforms 
and  maintenance. 

Living  Arrangements:  students  live  at  home,  in 
a college  dormitory  or  other  approved  resi- 
dence. 

Graduate  is  eligible  to  take  the  state  examina- 
tion for  licensure  as  a registered  nurse 
(“R.N.”). 

College  of  Lake  County 
Department  of  Nursing 
19351  West  Washington 

HARVEY 

Thornton  Community  College 
Department  of  Nursing 
151st  St.  & Broadway 

JOLIET 

Joliet  Junior  College 
201  E.  Jefferson 

KANKAKEE 

Kankakee  Community  College 
Department  of  Nursing 
River  Road 

MOLINE 

Black  Hawk  College 

Department  of  Nursing 
1001  Sixteenth  St. 

NORTHLAKE 

Triton  College 

Department  of  Nursing 
1000  Wolf  Rd. 

OGLESBY 

Illinois  Valley  Community  College 
Department  of  Nursing 
R.R.  #1  61348 

OLNEY 

Olney  Central  College 

305  N.  West  St.  62450 

PALATINE 

William  Rainey  Harper  College 
Department  of  Nursing 
Algonquin  & Roselle  Roads  60067 

RIVER  GROVE 

Triton  College 

Department  of  Nursing 

2000  Fifth  Avenue  60171 

ROCKFORD 

Rock  Valley  College 

Associate  Degree  Nursing  Program 
3301  N.  Mulford  Rd.  61111 


60030 

60164 

60432 

60901 

61265 

60164 


396 


Illinois  Medical  Journal 


Associate  Degree  Programs  Now  Being  Developed 


CHICAGO 

Kennedy-King  College 

Department  of  Nursing 

7047  South  Stewart  Ave 

Chicago  60621 

GALESBURG 

Carl  Sandburg  College 

Department  of  Nursing 
139  South  Cherry  Street 
Galesburg  61401 


SUGAR  GROVE 

Waubonsee  College 

Department  of  Nursing 

Illinois  Route  #47  & Harper  Road 

Sugar  Grove  60554 


Baccalaureate  Degree 
Nursing  Program 

Usually  a coeducational  nursing  program  under 
the  auspices  of  a college  or  university,  this  is  gen- 
erally four  academic  or  calendar  years  in  length. 
The  curriculum  combines  general  education  with 
nursing  education,  leading  to  the  Bachelor  of  Sci- 
ence Degree  in  Nursing.  Liberal  education  courses, 
such  as  arts  and  sciences,  are  shared  with  all  col- 
lege students.  University  medical  centers  and  other 
related  hospital  and  community  health  agencies  are 
utilized  for  nursing  theory  and  practice. 

Graduates,  both  men  and  women,  are  prepared 
for  beginning  nursing  positions  in  hospitals,  nurs- 
ing homes  and  community  health  services,  and  for 
advancement  without  further  formal  education  to 
positions  such  as  “nursing  team”  leader  or  head 
nurse.  They  also  have  the  foundations  for  con- 
tinuing personal  and  professional  development 
and  for  graduate  study  and  specialization  in  nurs- 
ing. 

BLOOMINGTON 

Illinois  Wesleyan  University 

Brokaw  Collegiate  School  of 
Nursing 

CHICAGO 

DePaul  University 

Department  of  Nursing 
25  E.  Jackson  Blvd. 

Loyola  University 

School  of  Nursing 
6526  N.  Sheridan  Rd. 

North  Park  College 

Department  of  Nursing 
5125  N.  Spaulding  Ave. 


General  Entrance  Requirements: 

Good  health. 

High  school  graduation:  college  preparatory 
program  including  biology  and  physical  sci- 
ences (1-2  units  of  chemistry  recommended) 
and  mathematics  (1-2  units).  Two  years  of 
a foreign  language  may  be  required.  Meets 
college  or  university  admission  standards. 

Cost:  college  or  university  tuition  fees  for  nurs- 
ing programs  are  comparable  to  those  for 
other  majors.  Range  in  Illinois  is  from  ap- 
proximately $1,000  to  $7,000  for  tuition  and 
fees  for  total  program.  Other  expenses:  books, 
uniforms,  maintenance. 

Living  Arrangements:  students  live  at  home,  in 
a college  dormitory  or  other  approved  residence. 

Graduate  is  eligible  to  take  state  examination 
for  licensure  as  a registered  nurse  (“R.N.”). 

St.  Xavier  College 

School  of  Nursing 
103  rd  & Central  Park 
University  of  Illinois 
College  of  Nursing 
P.O.  Box  6998 
845  S.  Damen 

DEKALB 

Northern  Illinois  University 
School  of  Nursing 

EDWARDSVILLE 

Southern  Illinois  University 
Edwardsville  Campus 
Department  of  Nursing 

KANKAKEE 

Olivet  Nazarene  College 
Department  of  Nursing 


61701 

60604 

60626 

60625 


60655 


60612 


60115 


62025 


60901 


PEORIA 

Bradley  University 

Department  of  Nursing  61606 


for  October,  1970 


397 


Diploma  (Hospital) 

Nursing  Program 

A nursing  program  under  the  auspices  of  a 
hospital  or  independent  school  of  nursing,  two  to 
three  years  in  length,  and  leading  to  a Diploma 
in  Nursing.  A college  or  university  may  provide 
some  of  the  courses.  The  curriculum  consists  of 
theory  and  practice  focused  primarily  on  instruc- 
tion and  related  clinical  experience  in  the  nursing 
care  of  patients  in  hospitals.  Some  liberal  arts 
courses  may  be  included. 

Graduates,  both  men  and  women,  have  the 
understanding  and  skills  necessary  to  organize 
and  implement  a plan  of  nursing  that  will  meet 
the  immediate  needs  of  one  or  more  patients 
and  that  will  promote  the  restoration  of  health. 
They  are  also  able  to  plan  with  associated  health 
personnel  for  the  care  of  patients,  and  may  be 


ALTON 

Alton  Memorial  Hospital 

Memorial  Drive  62002 

St.  Joseph’s  School 

915  E.  Fifth  St.  62004 

AURORA 

Copley  Hospital 

Lincoln  & Weston  60507 

BLOOMINGTON 

Mennonite  Hospital 

804  N.  East  Main  61701 

CANTON 

Graham  Hospital 

210  W.  Walnut  St.  61520 

CHAMPAIGN 

Burnham  City  Hospital 

404  S.  Third  St.  61822 

CHICAGO 

Augustana  Hospital 

411  Dickens  Ave.  60614 

Chicago  Wesley  Memorial  Hospital 

250  E.  Superior  St.  60611 

Cook  County  Hospital 

1900  W.  Polk  St.  60612 

Illinois  Masonic  Hospital 

836  Wellington  Ave.  60657 

James  Ward  Thorne — 

Passavant  Memorial  Hospital 
244  East  Pearson  St.  60611 

Michael  Reese  Hospital  and  Medical  Center 
2816  S.  Ellis  Ave.  60616 

Mount  Sinai  Hospital  & Medical  Center 

2730  W.  15th  Place  60608 

Ravenswood  Hospital  & Medical  Center 

1931  W.  Wilson  Ave.  60640 

St.  Anne’s  Hospital 

4950  W.  Thomas  St.  60651 

St.  Bernard’s  Hospital 

6344  S.  Harvard  Ave.  60621 

St.  Mary  of  Nazareth  Hospital 

1127  N.  Oakley  Blvd.  60622 

South  Chicago  Community  Hospital 

2320  E.  93rd  St.  60617 


responsible  for  the  direction  of  other  member' 
of  the  nursing  team. 

General  Entrance  Requirements: 

Good  health. 

High  school  graduation:  Usually  upper  half  of 
class,  with  courses  in  biological  and  physical 
sciences  (1-2  units,  one  of  which  should  be 
chemistry)  and  mathematics  (1-2  units). 

Satisfactory  results  on  entrance  tests  and  quali- 
fication for  admission  to  the  school. 

Cost:  $900  to  $3,500;  some  include  full  mainte- 
nance. 

Living  Arrangements:  Schools  have  residence  fa- 
cities;  many  permit  students  to  live  at  home 
if  preferred. 

Graduate  is  eligible  to  take  the  state  examina- 
tion for  licensure  as  a registered  nurse 
(“R.N.”). 


DANVILLE 

Lake  View  Memorial  Hospital 

812  N.  Logan  Ave.  61833 

DECATUR 

Decatur  Memorial  Hospital 

2300  N.  Edward  St.  62526 

EVANSTON 

Evanston  Hospital 

2645  Girard  Ave.  60201 

St.  Francis  Hospital 

319  Ridge  Ave.  60202 

FREEPORT 

Freeport  Memorial  Hospital 

1133  W.  Stephenson  61032 

GALESBURG 

Galesburg  Cottage  Hospital 

674  N.  Seminary  Ave.  61401 

JACKSONVILLE 

Passavant  Memorial  Area  Hospital 

1600  W.  Walnut  St.  62650 


JOLIET 

St.  Joseph  Hospital 

333  N.  Madison  St. 

MOLINE 

Lutheran  Hospital 
555  Sixth  St. 

Moline  Public  Hospital 
635  Tenth  Avenue 
OAK  LAWN 

Evangelical  (Christ  Community  Hospital) 


4440  W.  95th  St.  60453 

OAK  PARK 

West  Suburban  Hospital 

518  N.  Austin  Blvd.  60302 

PARK  RIDGE 

Lutheran  General  and  Deaconness  Hospital 
1700  Western  Ave.  60068 

PEORIA 

Methodist  Hospital  of  Central  Illinois 

221  N.E.  Glen  Oak  61603 

St.  Francis  Hospital 

211  Greenleaf  St.  61603 


60435 

61265 

61265 


398 


Illinois  Medical  Journal 


QUINCY 

ROCK  ISLAND 

Blessing  Hospital 

St.  Anthony  Hospital 

1005  Broadway 

62301 

767  Thirtieth  St. 

61201 

ROCKFORD 

SPRINGFIELD 

Rockford  Memorial  Hospital 

Memorial  Hospital 

2400  N.  Rockton  Ave. 

61103 

200  N.  Dodge  St. 

62701 

St.  Anthony  Hospital 

St.  John’s  Hospital 

5666  E.  State  St. 

61101 

401  N.  Ninth  St. 

62701 

Swedish-American  Hospital 

1316  Charles  St. 

61101 

Practical  Nursing  Program 

A coeducational  nursing  program  under  the 
auspices  of  public  vocational  education  systems, 
hospitals  or  community  agencies,  usually  one 
year  in  length.  The  curriculum  includes  nursing 
theory  coordinated  with  nursing  practice. 

Graduates,  both  men  and  women,  of  programs 
in  practical  nursing  are  prepared  for  two  roles: 


( 1 ) under  the  supervision  of  a professional  nurse 
or  physician,  they  give  nursing  care  to  patients 
in  situations  relatively  free  of  scientific  complex- 
ity; (2)  in  a close  working  relationship,  they 
assist  the  professional  nurse  in  giving  care  to  pa- 
tients requiring  a high  degree  of  nursing  skill 
and  judgment. 


Entrance  Requirements: 

Good  health. 

High  school:  Two  years  minimum,  graduation 
desirable.  Junior  and  senior  students  who  are 
currently  enrolled  in  high  school  are  eligible 
to  enroll  in  the  practical  nursing  program  as 
part  of  their  credit  curriculum. 

Satisfactory  results  on  entrance  tests. 

References  and  personal  interview. 

Cost:  None  under  MDTA  programs,  to  approxi- 
mately $400  plus  maintenance. 

Living  Arrangements:  Students  usually  live  at 
home  or  in  housing  approved  by  school. 
Graduate  is  eligible  to  take  the  state  examina- 
tion for  licensure  as  a practical  nurse 
(“L.P.N.”). 

ALTON 

F.  W.  Olin  School  of  Practical  Nursing 

2512  Amelia  Street  62002 

BLOOMINGTON 

Bloomington  School  of  Practical  Nursing 
709  S.  Clinton  St.  61701 

CAIRO 

Cairo  School  of  Practical  Nursing 

1615  Commercial  Street  62914 

CARBONDALE 

Southern  Illinois  University  Vocational  Tech- 
nical Institute  of  Practical  Nursing  62901 
CHAMPAIGN 

Champaign  School  of  Practical  Nursing 

103  N.  Prospect  Ave.  61821 

CHICAGO 

Chicago  Public  Schools  Practical  Nursing 
Center 

1820  W.  Grenshaw  60612 

Chicago  Public  Schools  Licensed  Practical 
Nurses  Program,  Manpower  Division 
2913  N.  Commonwealth  60657 

St.  Frances  X.  Cabrini  School  of  Practical 
Nursing 

811  S.  Lytle  St.  60607 


DANVILLE 

Danville  School  of  Practical  Nursing 

305  W.  Madison  St.  61833  J 

DECATUR  : 

Decatur  School  of  Practical  Nursing 

210  W.  North  St.  62522  n 

DES  PLAINES  ^ 

Niles  Township  H.  S.  School  of  Practical 

Nursing  [ 

Oakton  & Edens  Expressway  60018  J 

DIXON  S 

Sauk  Valley  College  C 

River  Campus  Route  #1  61021  2 

EAST  PEORIA 


Illinois  Central  College  Practical  Nursing 
Program,  Health  Education 
3202  N.  Wisconsin  61603 


EAST  ST.  LOUIS 

School  of  Practical  Nursing 

905  Ohio  St.  62205 


GALESBURG 

Carl  Sandburg  College,  Department  of  Prac- 
tical Nursing 

Box  1407,  South  Lake  Storey  Road  61401 
Galesburg  Practical  Nurse  Program 

650  Locust  St.  61401 


HARRISBURG 

Southeastern  Illinois  College,  School  of  Prac- 
tical Nursing 

333  W.  College  St.  62946 

HINSDALE 

Hinsdale  Hospital  School  of  Practical  Nursing 

120  N.  Oak  St.  60521 

JACKSONVILLE 

Jacksonville  Board  of  Education  School  of 
Practical  Nursing 

504  E.  Court  St.  62650 

JOLIET 

Joliet  Township  H.S.  School  of  Practical 
Nursing 

201  E.  Jefferson  St.  60432 


for  October,  1970 


399 


KANKAKEE 

Kankakee  School  of  Practical  Nursing 

293  E.  Court  St.  60901 

KARNAK 

Shawnee  Community  College  Practical  Nurs- 
ing Program 

206  E.  First,  P.O.  Box  237  62956 

LASALLE 

St.  Mary’s  Hospital  School  of  Practical 
Nursing 

1015  O'Connor  St.  61301 

MALTA 

Kishwaukee  Community  College  of  Practical 
Nursing 

Malta  60150 

MATTOON 

Lakeland  College 

School  of  Practical  Nursing 

1921  Richmond  61938 

MOLINE 

Black  Hawk  College  Practical  Nursing 
Program 

1001-16th  St.  61265 

MT.  CARMEL 

Wabash  Valley  College  Practical  Nursing 
Program 

2222  College  Dr.  62863 

MT.  VERNON 

Rend  Lake  College  Practical  Nursing  Program 
315  South  7th  62864 

OAK  FOREST 

Oak  Forest  Hospital  School  of  Practical 
Nursing 

15900  S.  Cicero  60452 


PALATINE 

William  Rainey  Harper  Practical  Nurse 
Program 

Algonquin  & Roselle  Roads  60067 

PEKIN 

Pekin  Practical  Nurse  Program 

East  Campus  61554 

PEORIA 

Peoria  School  of  Practical  Nursing 

509  W.  High  St.  61606 

QUINCY 

Quincy  School  of  Practical  Nursing 

820  Vermont  Street  62301 

RIVER  GROVE 

Triton  Junior  College,  Practical  Nursing 
Program 

2000  N.  Fifth  Ave.  60171 

ROCKFORD 

Rockford  School  of  Practical  Nursing 

201  S.  Madison  61101 

SKOKIE 

Niles  Township  H.S.  School  of  Practical 
Nursing 

Oakton  and  Edens  Expressway  60018 
SPRINGFIELD 

Springfield  School  of  Practical  Nursing 

nOl  S.  15th  St.  62704 

STREATOR 

Streator  Township  High  School 
Practical  Nurse  Program 

600  N.  Jefferson  61364 

WAUKEGAN 

College  of  Lake  County  Practical  Nurse 
Program 

312  Glen  Flora  60085 


400 


Illinois  Medical  Journal 


ILLINOIS  STATE  GOVERNMENT 


The  state  government  is  divided  into  three 
branches — legislative,  executive,  and  judicial.  The 
legislative  power  is  vested  in  the  General  Assem- 
bly, which  is  composed  of  the  State  Senate  and 
the  House  of  Representatives  (a  bicameral  as- 
sembly). 

For  representation  in  the  General  Assembly, 
there  are  58  senatorial  districts  and  59  represen- 
tative districts.  Each  senate  district  elects  one 
senator;  each  representative  district  elects  three 
representatives.  Thus,  the  Senate  has  58  members 
and  the  House  177.  The  senators  are  elected  for 
four-year  terms,  and  the  representatives  serve  two- 
year  terms.  Under  normal  procedure.  Senators  in 
the  districts  having  even  numbers  are  elected  in 
Presidential  election  years;  those  in  districts  with 
odd  numbers  are  chosen  at  elections  in  the  inter- 
vening even-numbered  years.  However,  recent  re- 
quirements for  reapportionment  have  created 
changes  in  this  pattern. 


The  General  Assembly  normally  meets  in  the 
first  six  months  of  each  odd-numbered  year.  Re- 
cently, because  of  annual  budgeting  by  the  Ad- 
ministration, special  sessions  have  been  called 
during  the  even  numbered  years.  The  General 
Assembly’s  functions  are  to  enact,  amend,  or  re- 
peal laws  or  adopt  appropriation  bills,  act  on 
amendments  to  the  United  States  Constitution, 
propose  and  submit  amendments  to  the  State 
Constitution,  and  to  act  to  remove  public  officials. 

When  the  House  of  Representatives  is  organized, 
a Speaker  or  presiding  officer  is  elected  for  the 
biennium.  The  presiding  officer  of  the  Senate  is 
the  Lieutenant  Governor.  To  facilitate  the  hand- 
ling of  legislation,  the  members  of  the  Senate 
and  House  are  assigned  to  designated  committees 
to  consider  bills  of  like  subject  matter.  These 
committees  usually  hold  public  hearings  to  dis- 
cuss legislation  before  the  measure  is  taken  up 
by  the  entire  House  or  Senate.  There  are  approxi- 
mately 50  committees. 


for  October,  1970 


401 


EXECUTIVE  BRANCH 


The  Constitution  provides  that  the  Executive 
Department  shall  consist  of  the  Governor,  Lieu- 
tenant Governor,  Secretary  of  State,  Auditor 
of  Public  Accounts,  Treasurer,  Superintend- 


ent of  Public  Instruction,  and  Attorney  General. 
All  of  these  officials  are  elected  for  four-year 
terms.  The  Treasurer  is  the  only  elected  state 
official  who  cannot  succeed  himself. 


LEGISLATIVE  BRANCH 


Legislative  Procedure 

Each  member  of  the  General  Assembly  has  the 
right  to  introduce  bills  or  resolutions.  When  a 
bill  is  introduced  it  is  read  at  large  a first  time, 
ordered  printed,  and  referred  to  the  proper  com- 
mittee for  consideration,  except  that  in  case  of 
an  emergency,  a bill  may  be  advanced  without 
reference  to  committee.  If  the  committee  recom- 
mends the  bill  favorably,  it  is  sent  to  second  read- 
ing when  amendments  to  it  can  be  offered  for 
consideration  by  the  entire  membership.  The  bill 
will  then  be  given  a third  and  final  reading  when 
it  is  acted  upon  by  the  entire  membership  of  the 
house  that  is  considering  it. 

Action  by  Both  Houses 

To  pass,  the  bill  must  receive  the  favorable  vote 
of  the  majority  of  the  members  elected  (89  in 
the  House;  30  in  the  Senate).  These  bills  are 
then  sent  to  the  other  house  where  essentially 
the  same  procedure  is  followed. 

If,  because  of  amendments  in  the  second  house, 
there  are  two  versions  of  the  same  bill,  confer- 
ence committees  may  be  appointed  to  work  out 
the  differences.  Both  houses  must  vote  favorably 
on  the  same  version  of  the  bill  before  it  can  be 
sent  to  the  Governor  for  his  consideration. 

If  the  Governor  thinks  the  bill  should  become 
a law,  he  can  either  sign  it  or  file  it  with  the 
Secretary  of  State  without  his  signature.  If  the 
Governor  decides  it  would  be  unwise  for  the  bill 
to  become  law,  he  can  veto  it.  If  he  vetoes  the 
bill,  he  must  file  a statement  of  objections.  Two- 
thirds  of  the  members  elected  to  the  House  can 
override  the  veto.  He  can  also  veto  specific  items 
of  an  appropriation  bill. 

Appropriation  Bills 

“Bills  making  appropriations  of  money  out  of 


the  treasury  shall  specify  the  objects  and  purposes 
for  which  the  same  are  made,  and  if  the  Gover- 
nor shall  not  approve  any  one  or  more  of  the 
items  or  sections  contained  in  any  bill,  but  shall 
approve  the  residue  thereof,  it  shall  become  a law 
as  to  the  residue  in  like  manner  as  if  he  had 
signed  it.  The  Governor  shall  then  return  the 
bill  with  any  objections  to  the  items  or  sections 
of  the  same  not  approved  by  him  to  the  House 
in  which  the  bill  shall  have  originated,  which 
House  shall  enter  the  objections  at  large  upon 
its  journal  and  proceed  to  reconsider  so  much  of 
said  bill  as  is  not  approved  by  the  Governor.  Any 
item  or  section  of  said  bill  not  approved  by  the 
Governor  shall  be  passed  by  two-thirds  of  the 
members  elected  to  each  of  the  two  Houses  of 
the  General  Assembly,  it  shall  become  part  of 
said  law,  notwithstanding  the  objections  of  the 
Governor.  Any  bill  which  shall  not  be  returned 
by  the  Governor  within  ten  days,  Sundays  ex- 
cepted, after  it  shall  have  been  presented  to  him, 
shall  become  a law  in  like  manner  as  if  he  had 
signed  it,  unless  the  General  Assembly  shall,  by 
their  adjournment,  prevent  its  return,  in  which 
case  it  shall  be  filed  with  his  objections  in  the 
office  of  the  Secretary  of  State  within  ten  days 
after  such  adjournment  or  become  a law.”  (Article 
V,  Section  16,  Illinois  Constitution) 


NOTE 

A Legislative  Directory  containing  the  names  and 
addresses  of  all  members  of  the  76th  Illinois 
General  Assembly  and  the  Illinois  Senators  and 
Representatives  in  the  Congress  is  available.  Re- 
quests should  be  directed  to:  Illinois  State  Medical 
Society,  Regional  Office,  520  S.  Sixth  St.,  Spring- 
field,  62701. 


STATE  OFFICERS 


Governor,  Richard  B.  Ogilvie,  Rep.,  Chicago 
Lieutenant  Governor,  Paul  M.  Simon,  Dem.,  Troy 
Secretary  of  State,  Paul  Powell,  Dem.,  Vienna 
Auditor  of  Public  Accounts,  Michael  J.  Howlett, 
Dem.,  Chicago 

State  Treasurer,  Adlai  E.  Stevenson,  III,  Dem., 
Chicago 


Attorney  General,  William  J.  Scott,  Rep.,  Evan- 
ston 

Superintendent  of  Public  Instruction,  Ray  Page, 
Rep.,  Springfield 

Clerk  of  the  Supreme  Court,  Justin  Taft,  Rep., 
Rochester 


402 


Illinois  Medical  Journal 


DEPARTMENT  OF  PUBLIC  AID 


The  Illinois  Department  of  Public  Aid  admin- 
isters the  federally  aided  public  assistance  pro- 
grams: Assistance  to  the  Aged,  Blind  or  Disabled; 
Aid  to  Dependent  Children;  and  Medical  Assist- 
ance. In  addition,  the  department  allocates  state 
funds  to  qualified  governmental  units  for  the  ad- 
ministration of  General  Assistance;  and  in  co- 
operation with  the  United  States  Department  of 
Agriculture,  administers  the  Food  Stamp  program. 

Administrative  Staff 

Harold  O.  Swank,  Director 
Gershom  Hurwitz,  Deputy  Director 
Robert  L.  Hyde,  Chief,  Division  of  Accounting 
Garrett  W.  Keaster,  Chief,  Division  of 
Administrative  Services 

Frank  P.  Higgins,  Chief,  Division  of  Adult  Edu- 
cation and  Child  Care 
James  M.  Brown,  Chief,  Division  of 
Downstate  Operations 
Henry  A.  Holle,  M.D.,  Medical  Director, 
Division  of  Medical  Services 
Robert  G.  Wessel,  Chief,  Medical  Administration 
Kenneth  E.  Doeblin,  Chief,  Division  of 
Methods  and  Data  Services 
Gordon  G.  Watters,  Chief,  Division  of  Program 
Development 

Wayne  D.  Epperson,  Chief,  Division  of 
Research  and  Statistics 
Richard  N.  Hosteny,  Chief,  Division  of 
Special  Investigations 

William  M.  Fishback,  Chief,  Division  of  Special 
Services 

Kegional  Offices 

Region  I - — Peoria  Frank  G.  Blumb, 

Regional  Director 

Region  II  — Champaign  C.  H.  Colwell, 

Regional  Director 

Region  III — Springfield  Robert  A.  Hamrick, 
Regional  Director 

Region  IV — Belleville  Armin  A.  Rippelmeyer, 

Regional  Director 
Region  V Marion  Lawrence  E.  Duff 

Regional  Director 

Region  VI — Rockford  Reno  L.  Lenz, 

Regional  Director 

Medical  Care  Advisory  Committee 

Murray  H.  Finley,  Chicago 

Mrs.  Mary  L.  Ford,  Chicago 

Samuel  A.  Goldsmith,  Chicago 

Mrs.  Jeannette  Kramer,  Palatine 

Chauncey  C.  Maher,  Jr.,  M.D.,  Springfield 

Frank  McCallister,  Chicago 

B.  E.  Montgomery,  M.D.,  Harrisburg 

Robert  C.  Muehrcke,  M.D.,  Oak  Park 

Harold  W.  Pratt,  R.Ph.,  Chicago 


State  Medical  Advisory  Committee 
Louis  Arp,  Jr.,  M.D.,  Moline 
Charles  E.  Baldree,  M.D.,  Belleville 
James  R.  Cooper,  M.D.,  Quincy 
Earl  E.  Fredrick,  Jr.,  M.D.,  Chicago 
Frank  J.  Jirka  Jr.,  M.D.,  Berwyn 
Paul  F.  LaFata,  M.D.,  Springfield 
George  F.  Lull,  M.D.,  Chicago 
Rex  O.  McMorris,  M.D.,  Peoria 
George  T.  Mitchell,  M.D.,  Marshall 
Robert  C.  Muehrcke,  M.D.,  Oak  Park 
Jacob  E.  Reisch,  M.D.,  Springfield 
.Alphonse  L.  Robinson,  M.D.,  Mounds 
Philip  G.  Thomsen,  M.D.,  Dolton 
Ered  A.  Tworoger,  M.D.,  Chicago 

State  Drug  Advisory  Committee 

W.  Edwin  Brown,  R.Ph.,  Quincy 

Carl  V.  Daschka,  R.Ph.,  Chester 

H.  M.  F.  Doden,  Sr.,  R.Ph.,  Rock  Island 

Justin  Eisele,  R.Ph.,  East  St.  Louis 

Louis  Gdalman,  R.Ph.,  Chicago 

John  T.  Gulick,  R.Ph.,  Danville 

John  F.  Koller,  R.Ph.,  Berwyn 

Roy  B.  Maher,  R.Ph.,  Springfield 

Harold  W.  Pratt,  R.Ph.,  Chicago 

Theodore  R.  Sherrod,  M.D.,  Ph.D.,  Chicago 

Harold  J.  Shinnick,  R.Ph.,  Chicago 

Charles  P.  Skaggs,  R.Ph.,  Harrisburg 

.State  Dental  Advisory  Committee 
John  C.  Barrett,  D.D.S.,  Freeport 
John  J.  Byrne,  D.D.S.,  Chicago 
Chauncey  Cross,  D.D.S.,  Springfield 
Vernon  J.  Haas,  D.D.S.,  Bloomington 
Lewis  K.  Holzman,  D.D.S.,  Chicago 
Robert  B.  Jans,  D.D.S.,  Evanston 
D.  J.  McCullough,  D.D.S.,  Wayne  City 
H.  B.  Riley,  D.D.S.,  Newton 
William  J.  Rogers,  D.D.S.,  Chicago 
Carl  L.  Sebelius,  D.D.S.,  Springfield 
Harold  H.  Sitron,  D.D.S.,  Chicago 

State  Advisory  Committee  on 

Croup  Care  Facilities 

Don  T.  Barry,  Raymond 

Taylor  O.  Braswell,  Belleville 

Bert  Cohn,  Okawville 

Mrs.  Rachel  Dodson,  Herrin 

William  K.  Ford,  M.D.,  Rockford 

Markham  D.  Hay,  Rockford 

Mrs.  Bernice  Hover,  Chicago 

Elmer  Johnson,  Joliet 

Mrs.  Laverta  Johnson,  Chicago 

Mrs.  Jeannette  Kramer,  Palatine 

Robert  E.  Lanier,  Springfield 

Roger  F.  Sondag,  M.D.,  M.P.H.,  Springfield 


for  October,  1970 


403 


Legislative  Advisory  Committee  on 
Public  Assistance 

The  Honorable  Merle  K.  Anderson,  Durand 
The  Honorable  Meade  Baltz,  Joliet 
The  Honorable  Charles  M.  Campbell,  Danville 
The  Honorable  John  W.  Carroll,  Park  Ridge 
The  Honorable  Corneal  A.  Davis,  Chicago 
The  Honorable  Daniel  Dougherty,  Chicago 
The  Honorable  Egbert  B.  Groen,  Pekin 
The  Honorable  James  G.  Krause,  East  St.  Louis 
The  Honorable  Robert  E.  Mann,  Chicago 
The  Honorable  Don  A.  Moore,  Midlothian 
The  Honorable  Esther  Saperstein,  Chicago 
The  Honorable  Ered  J.  Smith,  Chicago 

Board  of  Public  Aid  Commissioners 
Charles  A.  Davis,  Chicago 
Robert  G.  Gibson,  Chicago 
Robert  H.  MacRae,  Chicago 
Chauncey  C.  Maher,  Jr.,  M.D.,  Springfield 
Mrs.  Woods  McCausland,  Winnetka 
Thomas  A.  Nieman,  Rockford 
Robert  W.  Weissmiller,  Mount  Carroll 


Ex-Officio  members 

Albert  J.  Glass,  Acting  Director, 

Department  of  Mental  Health,  Springfield 
Edward  E.  Lis,  M.D.,  Director, 

Division  of  Services  for  Crippled  Children 
University  of  Illinois  College  of  Medicine, 
Chicago 

Alfred  Sheer,  Director, 

Division  of  Vocational  Rehabilitation,  Springfield 
Edward  T.  Weaver,  Director, 

Department  of  Children  and  Family  Services, 
Springfield 

Franklin  D.  Yoder,  M.D.,  M.P.H.,  Director, 
Department  of  Public  Health,  Springfield 

Department  of  Public  Aid  Representatives 
Henry  A.  Holle,  M.D.,  Medical  Director, 
Division  of  Medical  Services 
Robert  G.  Wessel,  Chief, 

Medical  Administration 
Division  of  Medical  Services 


DIVISION  OF  VOCATIONAL 
REHABILITATION 


The  Board  of  Vocational  Education  and  Re- 
liabilitation  is  a statutory  body,  established  to  ad- 
minister, through  two  operating  divisions,  the 
state  program  of  vocational  and  technical  edu- 


cation pursuant  to  the  Federal  Vocational  Edu- 
cation Act  as  amended,  and  the  state  program 
of  vocational  rehabilitation  pursuant  to  the  Fed- 
eral Vocational  Rehabilitation  Act  as  amended. 


Board  of  Vocational  Education  and  Rehabilitation 


Ex  Officio: 

Director  of  Agriculture 

Director  of  Labor 

Director  of  Mental  Health 

Director  of  Public  Health 

Director  of  Registration  and  Education 

Director  of  Children  and  Family  Services 

Superintendent  of  Public  Instruction 

Appointive  Members  (appointed  by  Governor)  : 
Helen  Schmid,  Glen  Ellyn 
James  D.  Broman,  Chicago 
Robert  Friedlander,  Chicago 
William  Gellman,  Ph.D.,  Chicago 
Edward  T.  Scholl,  Chicago 


Executive  Officers: 

For  vocational  education:  Ray  Page, 
Superintendent  of  Public  Instruction 
For  vocational  rehabilitation:  Alfred  Sheer, 
Director,  Division  of  Vocational  Rehabili- 
tation 

Division  of  Vocational  Rehabilitation 
Alfred  Sheer,  Director 

623  East  Adams,  Springfield  62706 

Division  of  Vocational  and  Technical  Education 
Sherwood  Dees,  Acting  Director 

405  Centennial  Building,  Springfield  62706 


DEPARTMENT  OF  CHILDREN  AND 
FAMILY  SERVICES 

Director’s  Office: 

Room  404,  New  State  Office  Bldg.,  Springfield 

Room  1713,  160  N.  LaSalle  St.,  Chicago 

Edward  T.  Weaver,  Director 


404 


Illinois  Medical  Journal 


Roman  L.  Haremski,  Deputy  Director 
William  J.  Lauf,  Deputy  Director  for  Manage- 
ment Services 

J.  Keller  Mack,  M.D.,  Medical  and  Public 
Health  Officer 

Philip  D.  Wynn,  Technical  Advisor 
Richard  S.  Laymon,  Administrative  Asst,  to  the 
Director  and  Guardianship  Administrator 
528  So.  Fifth  St.,  Springfield 
Office  of  Community  Relations: 

404  State  Office  Bldg.,  Springfield 
Donald  H.  Schlosser,  Administrator 
Office  of  Planning  and  Community  Development: 
Rm.  GL4,  525  W.  Jefferson,  Springfield 
William  H.  Ireland,  Director  of  Planning 
Thomas  Villiger,  Administrator  of  Community 
Development 

Division  of  Child  Welfare; 

528  S.  Fifth  St.,  Springfield 
Richard  J.  Bond,  Division  Director 
Herschel  L.  Allen,  Chief  of  Program  Services 
Merle  E.  Springer,  Chief  of  Metropolitan 
Operations 

Ralph  L.  Hanebutt,  Chief  of  Downstate 
Operations 

Regional  and  District  Offices — 

Aurora  Region  (Leland  Wright,  Reg.  Dir.), 
361  Old  Indian  Trail 
Aurora  District,  361  Old  Indian  Trail 
Joliet  District,  Rm.  309,  57  W.  Jefferson 
Waukegan  District,  4 S.  Genesee  St. 
Champaign  Region  (Thomas  L.  Tucker,  Reg. 
Dir.),  2125  So.  First  St. 

Champaign  District,  2125  S.  First  St. 
Bloomington  District,  309  W.  Market  St. 
Decatur  District,  125  N.  Franklin  St. 
Kankakee  District,  Rm.  300,  70  Meadow- 
view  Center 

Mattoon  District,  1000  Broadway 
Chicago  Region  (Ralph  Baur,  Reg.  Dir.), 
1026  S.  Damen  Avenue 
East  District,  2030  S.  Michigan  Ave. 
Herrick  House  Children’s  Center,  W.  Bart- 
lett Rd.,  Bartlett 

Lawndale  Day  Care  Center,  2929  W.  19th, 
Chicago 

East  St.  Louis  Region  (Jack  M.  Donahue, 
Reg.  Dir.),  310  N.  Tenth  St. 

East  St.  Louis  District,  917  Illinois  Avenue 
Olney  District,  1108  S.  West  St. 

Salem  District,  205  E.  Locust  St. 
Murphysboro  Region  (E.  Paul  Nelson,  Reg. 
Dir.),  9 South  12th  Street 
Murphysboro  District,  21  N.  11th  St. 
Cairo  Office,  529  Cross  St. 

Harrisburg  District,  10  S.  Vine  St. 
Metropolis  Office,  City  National  Bank  Bldg., 
P.O.  Box  757 

Southern  Illinois  Children’s  Service  Center, 
(James  W.  DeLeonardis,  Acting  Admin.), 
Hurst 

Peoria  Region  (Francis  R.  Paule,  Reg.  Dir.), 
5415  N.  University  Ave. 


Peoria  District,  5415  N.  University  Ave. 
Galesburg  District,  121  S.  Prairie 
Moline  District,  1805  Seventh  St. 
Princeton  Office,  22  E.  Marion 
Rockford  Region  (Margaret  M.  Kennedy, 
Reg.  Dir.),  4302  N.  Main  St.,  P.O.  Box  915 
Rockford  District,  4302  N.  Main  St.,  P.O. 
Box  915 

Ottawa  District,  412  W.  Madison  St. 
Rock  Falls  District,  203 1/2  First  Ave. 
Springfield  Region  (William  W.  Sanders, 
Reg.  Dir.),  Rm.  122,  4500  S.  Sixth  St.  Rd. 
Springfield  District,  Rm.  122,  4500  S.  Sixth 
St.  Rd. 

Carlinville  District,  494i/2  W.  Side  Square 
Jacksonville  District,  602  Westgate  Ave. 
Quincy  District,  410  N.  Ninth  St. 

Division  of  Educational  and 
Rehabilitation  Services ; 

404  State  Office  Bldg.,  Springfield 
Lee  A.  Iverson,  Division  Director 

Institutions — 

Illinois  Braille  and  Sight  Saving  School 
(Jack  Hartong,  Supt.),  Jacksonville 
Illinois  School  for  the  Deaf 

(Kenneth  Mangan,  Supt.),  Jacksonville 
Illinois  Children’s  Hospital-School 

(Paul  Kavanaugh,  Supt.),  1950  W.  Roose- 
velt Rd.,  Chicago 

Illinois  Soldiers’  and  Sailors’  Children’s  School 
(Andrew  Spelios,  Supt.),  Normal 
Charles  Adams,  Chief  of  Rehabilitation 
Services 

404  State  Office  Bldg.,  Springfield 

Institutions — 

Illinois  Soldiers’  and  Sailors’  Home 
(Richard  Northern,  Supt.),  Quincy 
Illinois  Visually  Handicapped  Institute 
(Thomas  Murphy,  Supt.),  1151  S.  Wood 
St.,  Chicago 

Visually  Handicapped  Services — 

Community  Services  for  the  Visually  Handi- 
capped 

(I.  N.  Miller,  Supt.),  Rm.  1700,  160  N. 
LaSalle  St.,  Chicago 

(Field  offices  located  in  regional  offices  in 
counties  other  than  Cook  County — see  list- 
ings under  Division  of  Child  Welfare) 
Raymond  M.  Dickinson,  Coordinator  of  Vis- 
ually Handicapped  Services 
404  State  Office  Bldg.,  Springfield 

Division  of  Financial  Management: 

404  State  Office  Bldg.,  Springfield 
Matthew  J,  Finnell,  Division  Chief 

Division  of  Systems  and  Data  Processing: 

630  E.  Adams  St.,  Springfield 
August  G.  Egger,  Jr.,  Division  Chief 

Division  of  Personnel  Administration: 

404  State  Office  Bldg.,  Springfield 
Thomas  A.  Nickell,  Chief  Personnel  Officer 


for  October,  1970 


405 


DEPARTMENT  OF  REGISTRATION  AND  EDUCATION 


William  H.  Robinson,  Director 
Allen  M.  Andreasen,  Deputy  Director 
Edward  Price,  Coordinator, 

Division  of  Professional  Supervision 

The  department  is  primarily  concerned  with 
the  registration,  licensing  and  enforcement  of 
32  laws  governing  the  different  professions,  trades 
and  occupations,  including  the  Medical  Practice 
Act.  Enforcement  of  the  Medical  Practice  Act 
is  in  the  Division  of  Professional  Supervision 
headed  by  a coordinator.  Registration  and  licen- 
sing is  under  the  jurisdiction  of  the  Division  of 
Registration. 

The  Medical  Examining  Committee  appointed 
by  the  director  of  the  department  operates  within 
the  framework  of  the  act  and  is  charged  with 
the  responsibility  of  giving  examinations  for 
licensure,  hearing  complaints  for  revocation  and 
suspension  of  licenses  and  promulgating  rules  and 
regulations  for  the  administration  of  the  act. 

Medical  Examining  Committee 

Eugene  Hoffman,  D.C. 

William  Johnson,  M.D. 

William  G.  McCarthy,  M.D. 

Dale  E.  Richardson,  D.O. 

Kenneth  H.  Schnepp,  M.D. 

Warren  D.  Tuttle,  M.D. 

Medical  Practice  Act 

Licensing  and  Enforcement  Procedures 

Illinois  statutes  provide  for  licensing  of  physi- 
cians to  practice  medicine  “(1)  in  all  of  its 

branches,  and  (2)  licensing  of  those  persons  to 

treat  human  ailments  without  the  use  of  drugs 
or  medicine  and  without  operative  surgery.” 

The  Medical  Practice  Act  states,  “no  person 
shall  practice  medicine  or  any  of  its  branches  or 
midwifery,  or  any  system  or  method  of  treating 
human  ailments  without  the  use  of  drugs  or  medi- 
cines, or  without  operative  surgery,  without  a 

valid  existing  license  so  to  do.”  Applicant  for 
license  must  pass  an  examination  of  his  qualifica- 
tions which  must  be  satisfactory  to  the  Depart- 
ment of  Registration  and  Education. 

Required  Education 

Minimum  standards  of  professional  education: 
2 years’  course  of  instruction  in  a college  of 

liberal  arts  or  its  equivalent,  or  in  such  medical 
college  in  a course  of  instruction  in  the  treat- 
ment of  human  ailments  which  course  shall  have 
been  not  less  than  132  weeks  in  duration  and 
shall  have  been  completed  within  a period  of 
not  less  than  35  months  and  in  addition,  a course 
of  clinical  training  of  not  less  than  12  months 
in  a hospital.  The  college  of  liberal  arts,  medical 
school,  and  hospital  must  be  reputable  and  in 
good  standing  in  the  judgment  of  the  Depart- 
ment of  Registration  and  Education. 


All  examinations  provided  by  the  Medical  Prac 
tice  Act  shall  be  conducted  by  the  Department  of 
R&E.  Examinations  of  applicants  who  seek  to 
practice  medicine  in  all  of  its  branches  which  shall 
embrace  the  subjects  of  which  knowledge  is  gen- 
erally required  of  candidates  for  the  degree  of 
Doctor  of  Medicine  by  reputable  medical  colleges 
in  the  U.S.,  and  shall  be  such  in  the  judgment 
of  the  Department  of  R&E  that  will  determine 
the  qualifications  of  applicants  to  practice  medicine 
in  all  of  its  branches. 

Every  license  issued  under  the  Act  expires  on 
July  1 of  each  even-numbered  year.  Every  licensee 
under  the  Act  may,  biennially  during  the  month 
of  June  of  each  even-numbered  year,  renew  his 
license  upon  paying  to  the  Department  a renewal 
fee  of  $10. 

Revocation  and  Suspension  of  License  or 
Certificate 

The  department  may  revoke  or  suspend  the 
license,  certificate,  or  state  hospital  permit  of 
any  person  licensed  under  the  act  upon  any  of 
the  following  grounds: 

“I.  Conviction  of  procuring  or  attempting  or  aid- 
ing to  procure  such  an  abortion  as  was  made 
unlawful  at  the  time  under  the  Criminal 
Code  of  this  State; 

2.  Conviction  in  this  or  another  state  of  any 
crime  which  is  a felony  under  the  laws  of 
this  state  or  conviction  of  a felony  in  a 
federal  court. 

3.  Gross  malpractice  resulting  in  permanent  in- 
jury or  death  of  a patient; 

4.  Engaging  in  dishonorable,  unethical  or  un- 
professional conduct  of  a character  likely 
to  deceive,  defraud,  or  harm  the  public; 

5.  Obtaining  a fee,  either  directly  or  indirectly, 
either  in  money  or  in  the  form  of  anything 
else  of  value  or  in  the  form  of  financial 
profit  as  personal  compensation,  or  as  com- 
pensation, charge,  profit  or  gain  for  an  em- 
ployer or  for  any  other  person  or  persons, 
on  the  fraudulent  representation  that  a mani- 
festly incurable  condition  of  sickness,  disease 
or  injury  of  any  person  can  be  permanently 
cured; 

6.  Habitual  intemperance  in  the  use  of  ardent 
spirits,  narcotics,  or  stimulants  to  such  an 
extent  as  to  incapacitate  for  performance 
of  professional  duties; 

7.  Holding  one’s  self  out  to  treat  human  ail- 
ments under  any  name  other  than  his  own, 
or  the  personation  of  any  other  physician; 

8.  Employment  of  fraud,  deception  or  any  un- 
lawful means  in  applying  for  or  securing  a 
license,  certificate,  or  state  hospital  permit 
to  practice  the  treatment  of  human  ailments 
in  any  manner,  to  practice  midwifery, 
or  in  passing  an  examination  therefor,  or 
willful  and  fraudulent  violation  of  the  rules 


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Illinois  Medical  Journal 


and  regulations  of  the  department  governing 
examinations; 

9.  Holding  one’s  self  out  to  treat  human  ail- 
ments by  making  false  statements,  or  by 
specifically  designating  any  disease,  or  group 
of  diseases  and  making  false  claims  of  one’s 
skill  or  the  efficacy  or  value  of  one’s  medi- 
cine, treatment  or  remedy  therefor; 

10.  Professional  connection  or  association  with, 
or  lending  one’s  name  to,  another  for  the 
illegal  practice  by  another  of  the  treatment 
of  human  ailments  as  a business,  or  profes- 
sional connection  or  association  with  any 
person,  firm,  or  corporation  holding  himself, 
themselves,  or  itself  out  in  any  manner  con- 
trary to  this  Act; 

11.  Revocation  or  suspension  of  a medical  li- 
cense in  a sister  state. 

12.  A violation  of  any  provision  of  this  Act  or 
of  the  rules  and  regulations  formulated  for 
the  administration  of  this  Act; 

13.  Except  as  otherwise  provided  in  Section 
16.01,  advertising  or  soliciting  by  himself  or 
through  another,  by  means  of  hand  bills,  pos- 
ters, circulars,  stereopticon  slides,  motion 
pictures,  radio,  newspapers  or  in  any  other 
manner  for  professional  business.” 

Section  16.01.  Any  person  licensed  under  this  Act 
may  list  his  name,  title,  office  hours,  address, 
telephone  number  and  any  specialty  in  profes- 
sional and  telephone  directories;  may  announce 
by  way  of  a professional  card  not  larger  than 
3Vz  inches  by  2 inches,  only  his  name,  title,  de- 
gree, office  location,  office  hours,  phone  num- 
ber, residence  address  and  phone  number  and 
any  specialty;  may  list  his  name,  title,  address 
and  telephone  number  and  any  specialty  in  public 
print  limited  to  the  number  of  lines  necessary 
to  state  that  information;  may  announce  his 
change  of  place  of  business;  absence  from,  or 
return  to  business  in  the  same  manner;  or  may 
issue  appointment  cards  to  his  patients,  when 
Information  thereon  is  limited  to  the  time  and 
place  of  appointment  and  that  information  per- 
mitted on  the  professional  card.  Listings  in  public 
print,  in  professional  and  telephone  directories, 
or  announcements  of  change  of  place  of  business, 
absence  from,  or  return  to  business,  may  not  be 
made  in  bold  faced  type. 

Rules  and  Regulations  Adopted  for  the 
Administration  of  the  Illinois  Medical 
Practice  Act,  Effective  March  18,  1955 

Rule  1 — Accredited  Colleges  of  Medicine  and 
Surgery 

Medical  colleges  having  rules  and  curricula 
commensurate  with  and  equivalent  to  the  rules 
and  curricula  of  the  College  of  Medicine  of  the 
University  of  Illinois,  will  be  considered  for  ac- 
creditation by  the  Department  of  Registration 
and  Education. 


Rule  II — Accredited  Colleges  Teaching  Sys- 
tems OF  Treating  Human  Ailments  With- 
out THE  Use  of  Drugs  or  Medicine  and 
Without  Operative  Surgery. 

A professional  college  or  institution  teaching  a 
system  of  treating  human  ailments  without  the 
use  of  drugs  or  medicine  and  without  operative 
surgery  shall  be  deemed  reputable  and  in  good 
standing  in  the  judgment  of  the  Department  upon 
submission  of  proof  of  the  following  requirements: 

(a)  That  a Dean  or  other  Executive  Officer, 
employed  on  a full-time  basis  supervises  the  stu- 
dents and  curriculum. 

(b)  That  the  faculty  is  comprised  of  gradu- 
ates in  their  specialty  from  recognized  professional 
colleges  or  institutions. 

(c)  That  the  faculty  is  organized  and  each  de- 
partment has  a director,  professors,  associate 
professors  and  assistant  professors,  each  respon- 
sible to  his  superior  for  his  instruction  in  the 
particular  subject  he  teaches. 

(d)  That,  annually,  a catalogue  or  brochure  is 
published  setting  forth  the  requisites  for  admis- 
sion to  the  college,  tuition  rates,  courses  offered, 
dates  of  sessions,  schedule  of  classes,  require- 
ments for  graduation,  a roster  of  the  undergradu- 
ate students  and  a roster  of  the  last  graduating 
class.  The  catalogue  or  brochure  shall  contain  a 
list  of  the  departments  of  the  school,  the  titles 
of  the  personnel  and  a brief  summary  of  each  per- 
son’s qualifications.  The  curriculum  shall  include, 
but  not  be  limited  to,  four  academic  years’  in- 
struction in  the  following  subjects: 

( 1 ) Anatomy 

(a)  Embryology 

(b)  Histology 

(c)  Neuro-anatomy 

(2)  Physiology  and  Chemistry 

(3)  Pathology  and  Bacteriology 

(4)  Diagnosis 

(a)  Physical 

(b)  Differential 

(c)  Laboratory 

(e)  That  suitable  buildings  provided  with  lab- 
oratories equipped  for  instruction  in  anatomy, 
chemistry,  physiology,  pathology,  bacteriology  and 
other  areas  of  learning  necessary  to  the  due  course 
of  study  prescribed  by  these  rules;  and  that  a 
laboratory  equipped  with  supplies,  models,  mani- 
kins, charts,  stereopticon,  roentgen-ray  and  other 
special  apparatus  used  in  teaching  the  system  to 
treat  human  ailments  without  the  use  of  medi- 
cine and  operative  surgery,  be  provided. 

(f)  That  a working  library,  easily  accessible  to 
students,  is  maintained  from  at  least  9 a.m.  to  5 
p.m.,  with  a librarian  in  constant  attendance.  The 
library  shall  conta-in  a standard  medical  diction- 
ary, the  modern  text  and  reference  books,  and 
the  files  of  leading  periodicals  dealing  with  the 
particular  system  of  treating  human  ailments  with- 
out the  use  of  medicine  and  operative  surgery. 

(g)  That  the  college  or  institution  requires  all 


for  October,  1970 


407 


students  to  furnish,  before  matriculation,  satisfac- 
tory proof  of  the  preliminary  education  required 
by  the  Medical  Practice  Act. 

(h)  That  full  and  complete  records  are  kept 
showing  the  credentials  for  admission,  attendance, 
grades  and  financial  accounts  of  each  student. 

(i)  That  admission  of  transfer  students  will  be 
limited  to  honorably  dismissed  students  from  an- 
other approved  college  or  institution  teaching  the 
same  system.  The  transcript  of  record  obtained 
directly  from  the  transferring  school  shall  be  kept 
on  file.  It  shall  be  the  duty  of  a college  or  insti- 
tution to  furnish  such  a transcript  for  the  benefit 
of  each  student  subject  to  honorable  dismissal.  No 
credit  shall  be  given  a transferred  student  for  final 
or  “senior  year”  work  or  for  any  courses  taken 
by  correspondence. 

(j)  That  students  shall  start  class  attendance 
within  one  week  of  the  start  of  each  session.  That 
credit  for  completion  of  a course  will  not  be 
granted  a student  who  failed  to  attend  80  per  cent 
of  the  complete  session  of  the  course. 

Rule  III — Hospitals  Approved  for  Internship. 

1.  A hospital  shall,  in  the  judgment  of  the  De- 
partment be  deemed  reputable  and  in  good  stand- 
ing for  training  Interns  and  intern  services  when 
it  meets  the  following  standards: 

(a)  General  hospital  of  150  beds’  capacity, 
with  an  average  of  at  least  60  patients  daily, 
with  rotating  service. 

(b)  Shall  contain  at  least  the  departments  of 
internal  medicine,  surgery,  obstetrics  and  pedi- 
atrics; and  an  organized  departmentalized  staff, 
holding  meetings  monthly  for  case  reviews  and 
study. 

(c)  Laboratory  employing  a full-time  qualified 
technician  and  at  least  a part-time  qualified 
pathologist,  visiting  the  laboratory  at  least  two 
days  per  week. 

(d)  Radiological  department  employing  a qual- 
ified X-ray  technician  and  at  least  a part-time 
qualified  roentgenologist,  visiting  the  depart- 
ment at  least  two  days  per  week. 

(e)  Maintenance  of  an  up-to-date  medical  li- 
brary located  in  a suitable  study  room  available 
to  interns. 

(f)  Such  hospital  shall  provide  and  furnish  the 
Department  with  the  names  of  staff  members 
of  the  various  departments  of  the  hospital. 

(g)  The  hospital,  upon  the  completion  of  a 
course  of  training  therein  of  not  less  than 
twelve  months,  shall  issue  its  certificate  there- 
for to  any  such  intern  or  at  the  request  of  the 
Department,  such  certificate  shall  include 
therein,  by  date,  the  commencement  and  the 
conclusion  thereof. 

2.  An  approved  internship  shall  consist  of  twelve 
months  rotating  service  in  medicine,  surgery, 
obstetrics  and  pediatrics,  with  an  election  in 
medical  specialties. 

In  the  event  an  applicant  has  received  training 


in  excess  of  the  twelve  months’  period  specified 
by  the  Medical  Practice  Act,  and  if  this  be  in  an 
institution  approved  by  the  Department  as  ade- 
quate for  specialty  training:  and  if  the  applicant 
has  received  certification  by  a recognized  Medical 
Specialty  Board,  and  has  had  two  or  more  years’ 
specialty  practice  or  Military  Service;  such  train- 
ing and  practice  may  be  accepted  as  the  equi- 
valent of  a rotating  internship. 

Any  applicant  who  shall  have  completed  twelve 
months  of  clinical  training  in  a hospital,  as  re- 
quired by  Section  5-1  (b)  of  the  Medical  Practice 
Act,  and  who  has  been  accepted  for  further  train- 
ing in  a specialty  or  general  practice  residency 
program  by  a hospital  or  institution  approved  by 
the  Department  for  that  purpose,  shall  be  deemed 
to  have  complied  with  the  requirements  of  this 
rule  and  of  the  Medical  Practice  Act  in  this 
regard. 

Rule  IV — Application  for  Examination 

An  applicant  for  examination  for  licensure  to 
practice  medicine  in  all  of  its  branches,  or  any 
system  of  treating  human  ailments  without  the 
use  of  drugs  or  medicine  and  without  operative 
surgery,  must  make  application  on  forms  fur- 
nished by  the  Department  at  least  fifteen  days 
prior  to  the  examination  and  present,  in  addition: 

(a)  Recommendations  from  two  (2)  physicians 
duly  licensed  to  practice  in  some  state  in  the 
United  States. 

(b)  A recent  photograph,  passport  size,  signed 
by  applicant  and  the  two  persons  licensed  to 
practice  the  system  of  treatment  of  human  ail- 
ments for  which  the  applicant  is  seeking  a 
license.  A duplicate  photograph  must  be  pre- 
sented with  the  card  of  admission  at  the  exami- 
nation. 

(c)  The  original  diploma  of  graduation  from 
the  professional  college  in  which  the  applicant 
completed  his  course  of  training,  or,  in  lieu  of 
presenting  the  diploma  with  the  application, 
the  applicant  may  present  it  at  the  examination, 
td)  A certified  copy  of  secondary  school  and 
professional  school  studies  to  be  mailed  direct 
to  the  Department  by  the  schools  attended  or 
by  the  professional  schools  where  the  applicant 
completed  the  required  course  of  study. 

(e)  Proof  of  completion  of  a rotating  intern- 
ship of  twelve  months  in  an  approved  hospital 
for  applicants  seeking  admission  to  examina- 
tion for  license  to  practice  medicine  in  all  of  its 
branches;  and,  in  the  case  of  graduates  of 
medical  colleges  in  countries  other  than  the 
United  States  and  Canada,  who  apply  for  ex- 
amination after  January  1,  1953,  proof  of  ro- 
tating internships  of  one  year  in  approved 
hospitals  in  the  United  States. 

A candidate  under  Section  5,  paragraph  Ib  or 
Section  13,  may  apply  for  the  examination  or 
clinical  test  and  take  the  examination  given 
immediately  prior  to  completion  of  his  intem- 


408 


Illinois  Medical  Journal 


ship  provided  he  furnishes  a statement  from 
the  hospital  authorities  stating  his  internship 
has  been  satisfactory  to  date.  The  results  of 
the  examination  will  be  withheld  and  no  li- 
cense will  be  issued  until  the  Department  re- 
ceives proof  of  satisfactory  completion  of  the 
required  internship  in  an  approved  hospital 
training  program. 

(f)  Applicants  who  completed  their  medical 
courses  in  the  extramural  colleges  of  Ireland 
and  Scotland  shall  not  be  eligible  for  admission 
to  examinations  for  licensure  under  the  Illinois 
Medical  Practice  Act. 

(g)  Graduates  of  European  colleges  or  uni- 
versities after  January  1,  1943,  with  the  ex- 
ception of  certain  approved  colleges  in  the 
British  Isles,  Denmark,  Holland,  Norway, 
Sweden  and  Switzerland,  be  not  accepted  for 
admission  to  examinations  for  licensure  under 
the  Illinois  Medical  Practice  Act. 

Graduates  of  such  European  medical  colleges 
after  January  1,  1943  may  be  considered  for 
admission  to  Illinois  examinations  provided 
they  present  diplomas  of  graduation  from  ap- 
proved medical  colleges  in  the  United  States 
after  attendance  in  such  colleges  for  at  least 
one  year;  and  in  addition,  have  served  rotating 
interships  of  one  year  in  approved  hospitals 
in  the  United  States. 

(h)  An  applicant  who  presented  a diploma  of 
graduation  from  an  approved  school  will  not 
be  accepted,  if  he  was  accorded  advanced  stand- 
ing in  such  school  based  upon  his  prior  edu- 
cation in  an  unapproved  school. 

Rule  V — Examinations 

1.  Examinations  for  licensure  to  practice  medi- 
cine in  all  of  its  branches  shall  be  conducted  in 
the  English  language  and  shall  be  in  the  following 
theoretical  and  practical  areas  of  medicine: 

Theoretical 

Chemistry 

Physiology 

Anatomy 

Pharmacology 

Pathology 

Bacteriology 

Medicine 

Public  Health  & Preventive  Medicine 

Obstetrics  & Gynecology 

Surgery 

Pediatrics 

Psychiatry 

Clinical 

General  Practice  of  Medicine 

2.  Examinations  for  licensure  to  practice  the 
treatment  of  human  ailments  without  the  use  of 
drugs  or  medicine  and  without  operative  surgery 
shall  be  conducted  in  the  English  language  and 
shall  be  in  the  following  theoretical  and  practical 
subjects; 

Theoretical 
Chemistry  & Physiology 
Anatomy  & Histology 


Pathology  & Bacteriology 
Diagnosis 

Hygiene  & Medical  Jurisprudence 
Eye,  Ear,  Nose,  & Throat 
Dermatology,  Pediatrics  & Neurology 
System  of  Practice 

Obstetrics  (of  graduates  of  approved  osteo- 
pathic colleges) 

Practical 

System  of  Practice 

3.  To  be  successful,  applicants  must  receive  gen- 
eral averages  of  75%  with  no  grade  below  60  in 
the  written  examination,  and  a general  average 
of  75%  in  the  clinical  or  practical  test. 

Applicants  applying  for  registration  under  Sec- 
tions 12  and  12a  of  the  Medical  Practice  Act  shall 
be  required  to  make  general  averages  of  75%  in 
the  three  subjects  required  for  license  to  practice 
medicine  and  surgery  in  Illinois. 

4.  In  case  of  failure  in  the  first  and  second  ex- 
aminations applicants  will  be  allowed  credit  on 
the  following  examination  for  all  grades  of  75  or 
more;  but  in  case  of  failure  in  the  third  examina- 
tion they  must  retake  all  written  subjects  at  each 
subsequent  examination.  It  is  not  required  that 
the  clinical  or  practical  part  of  the  examination 
be  repeated  after  a passing  grade  of  75  has  been 
received  in  that  part  of  the  examination. 

5.  Applicants  who  take  the  regular  examina- 
tion conducted  by  the  Department  for  licenses  as 
Physicians  and  Surgeons  shall  be  excused  from 
taking  the  clinical  test. 

6.  An  applicant  for  registration  as  Physician 
and  Surgeon  who  has  been  unsuccessful  in  five 
examinations  will  be  deemed  to  be  eligible  for  fur- 
ther examination  upon  receipt  of  proof  that  he 
has  completed  one  year  of  residency  training  in  an 
approved  hospital  training  program  in  the  United 
States  received  subsequent  to  the  applicant’s  fifth 
failure. 

7.  An  applicant  who  has  been  unsuccessful  in 
five  examinations  for  registration  as  a drugless 
practitioner  will  be  eligible  for  reexamination  upon 
receipt  of  proof  that  he  has  completed  a course 
of  study  of  960  hours  in  a school  which  is  ac- 
credited under  the  Medical  Practice  Act.  This 
course  must  be  received  subsequent  to  the  appli- 
cant’s fifth  failure. 

8.  An  applicant  who  furnished  proof  of  a 
course  of  study  of  240  hours  in  a school  of  chiro- 
practic recognized  by  the  Department  in  order 
to  be  eligible  for  further  examination  under  Sec- 
tion 9a  of  the  Medical  Practice  Act  will  be  con- 
sidered as  a new  applicant  and  his  grades  of  75 
per  cent  or  more  will  be  carried  over  to  the  sec- 
ond and  third  examinations. 

Rule  VI — Reciprocity 

1.  Each  applicant  for  registration  through  reci- 
procity, either  for  the  practice  of  medicine  in  all 


for  October,  1970 


409 


of  its  branches  or  for  the  treatment  of  human  ail- 
ments without  the  use  of  drugs  or  medicine  and 
without  operative  surgery,  filed  on  forms  provided 
by  the  Department,  will  be  considered  on  its  in- 
dividual merits,  provided  the  state  or  territory  of 
original  licensure  grants  a like  privilege  to  persons 
licensed  in  Illinois. 

2.  If  the  application  is  not  endorsed  by  offi- 
cers of  a state  or  county  society  it  must  be  en- 
dorsed by  two  (2)  physicians  duly  licensed  to 
practice  in  some  state  in  the  United  States. 

3.  Applicants  for  licensure  through  reciprocity 
or  upon  the  basis  of  having  passed  the  National 
Board  Examination  prior  to  January  1,  1964,  must 
pass  the  clinical  test  conducted  by  this  Depart- 
ment. Applicants  upon  the  basis  of  the  National 
Board  Examination  who  completed  Part  III  after 
January  1,  1964,  are  required  to  report  for  an 
interview  with  the  Medical  Examining  Committee. 
The  clinical  test  shall  be  such  in  the  judgment  of 
the  Committee  as  will  determine  the  qualifications 
of  the  applicant  to  practice  medicine  in  all  of  its 
branches,  taking  into  consideration  the  quality  of 
medical  education  and  clinical  training  or  practi- 
cal experience  which  the  applicant  has  had,  special 
honors  or  awards,  publications  in  recognized  and 
reputable  journals,  authorship  of  textbooks  in 
medicine,  and  any  other  circumstance  or  attribute 
that  the  Committee  accepts  as  evidence  of  an 
outstanding  and  proven  ability  in  any  branch  of 
the  field  of  medicine. 

4.  Graduates  of  Chiropractic  colleges  whose  ap- 
plications for  registration  in  Illinois  by  reciprocity 
are  approved,  shall  be  required  to  pass  a written 
examination  in  theory  in  addition  to  a practical 
test  before  the  chiropractic  examiner. 

Rule  VII — Licensure 

1.  An  examinate  who  successfully  completes  his 
medical  examination  must  secure  his  certificate  of 
licensure  within  one  year  from  the  date  of  his 
examination. 

2.  The  Department  will  not  issue  a duplicate 
certificate  of  registration  to  practice  medicine  in  all 
of  its  branches,  or  to  treat  human  ailments  without 
the  use  of  drugs  or  medicine  and  without  opera- 
tive surgery,  unless  proof  satisfactory  to  the  De- 
partment and  the  Committee  is  presented  that  the 
original  certificate  was  destroyed;  or  in  case  of 
change  of  name  when  the  original  certificate  is 
returned  for  cancellation,  together  with  satisfac- 
tory legal  proof  of  such  change  of  name. 

3.  A license  to  practice  medicine  in  Illinois 
shall  be  a requisite  for  a residency  in  an  Illinois 
hospital. 

Rule  VIII — ^Temporary  Certificates  of 
Registration 

1.  Any  person  not  licensed  to  practice  medicine 
in  all  of  its  branches  in  the  State  of  Illinois  who 
wishes  to  pursue  a program  of  graduate  or  spe- 
cialty or  residency  training  in  this  State,  must 
be  the  holder  of  a Temporary  Certificate  of 
Registration  issued  by  the  Department  under  the 


provisions  of  Section  11a  of  the  Medical  Practice 
Act  of  Illinois  and  in  accordance  with  the  provi- 
sions of  the  within  Rules. 

2.  Application  for  a Temporary  Certificate 
must  be  made  on  blank  forms  prepared  and  fur- 
nished by  the  Department.  It  must  be  submitted 
to  the  Department  together  with  evidence  satis- 
factory to  the  Department  that  applicant  meets 
the  requirements  of  Section  11a  of  the  Illinois 
Medical  Practice  Act  and  that  if  his  application 
is  approved  he  will  be  accepted  or  appointed  for 
the  residency  training  in  the  hospital  designated 
in  such  application. 

3.  A Temporary  Certificate  of  Registration  will 
be  issued  on  behalf  of  an  otherwise  qualified  appli- 
cant only  for  residency  or  specialty  training  in 
a hospital  situated  in  this  State  which  is  approved 
by  the  Department  for  the  purpose  of  such  train- 
ing. An  approved  hospital  is  one  which  in  the 
judgment  of  the  Department  is  qualified  to  offer 
such  training,  and  which  shall  comply  with  the 
within  Rules. 

4.  Written  notice  of  the  Department’s  final 
action  on  every  application  for  a Temporary 
Certificate  of  Registration  shall  be  given  to  the 
applicant  and  the  hospital  designated  therein; 
when  such  application  is  approved  the  Temporary 
Certificate  of  Registration  shall  be  delivered  or 
mailed  to  the  hospital  designated  therein  and  shall 
be  kept  in  the  care  and  custody  of  such  hospital. 
The  applicant  shall  not  commence  such  specialty 
or  residency  training  before  he  or  the  hospital 
receives  written  notification  of  approval  of  his 
application. 

5.  A Temporary  Certificate  of  Registration 
shall  not  be  valid  for  longer  than  one  year  after 
issuance  thereof  and  may  be  renewed  from  time 
to  time,  in  the  discretion  of  the  Department,  for 
a period  of  not  more  than  one  year  each  time. 
Application  for  renewal  must  be  made  on  forms 
prepared  and  furnished  by  the  Department  and 
the  Temporary  Certificate  of  Registration  sought 
to  be  renewed  must  be  submitted  therewith  to 
the  Department. 

6.  When  any  person  in  whose  behalf  a Tem- 
porary Certificate  of  Registration  has  been  issued 
shall  be  discharged  or  shall  terminate  his  specialty 
or  residency  training  in  the  hospital  designated 
therein,  such  hospital  shall  immediately  deliver 
or  mail  by  registered  mail  to  the  Department  his 
Temporary  Certificate  of  Registration  and  writ- 
ten notice  of  the  reason  for  return  of  same. 

7.  A Temporary  Certificate  of  Registration  is 
not  transferable  without  prior  notice  to  and  ap- 
proval by  the  Department.  If  the  holder  of  a 
Temporary  Certificate  of  Registration  wishes  to 
change  to  another  training  program  in  the  ap- 
proved hospital  designated  therein,  or  he  wishes 
to  enter  a training  program  in  another  approved 
hospital,  he  must  make  application  on  Forms  fur- 
nished by  the  Department.  His  current  Tempor- 
ary Certificate  of  Registration  must  accompany 
such  application  and  he  cannot  thereafter  continue 


410 


Illinois  Medical  Journal 


in  the  training  program  designated  on  such  cur- 
rent Certificate,  and  he  may  not  commence  such 
other  training  program  until  a Temporary  Certi- 
ficate of  Registration  has  been  issued  therefor. 

8.  Not  more  than  one  Temporary  Certificate 
of  Registration  shall  be  issued  to  any  person  for 
the  same  period  of  time.  A person  on  whose  be- 
half a Temporary  Certificate  of  Registration  has 
been  issued  is  limited  in  the  practice  of  medicine 
to  the  performing  of  such  acts  as  may  be  pre- 
scribed by  and  incidental  to  his  program  of  resi- 
dency training  in  the  hospital  designated  in  his 
Temporary  Certificate  of  Registration,  and  he 
cannot  otherwise  engage  in  the  practice  of  medi- 
cine in  the  State  of  Illinois. 

9.  Whenever,  under  the  within  Rules,  a hospital 
is  required  to  deliver  or  return  a Temporary  Cer- 
tificate of  Registration  to  the  Department,  in 
case,  because  of  the  loss  or  destruction  of  such 
Certificate,  or  for  any  other  reason,  such  hospital 
shall  be  unable  immediately  so  to  deliver  or  mail 
such  Certificate,  such  hospital  shall  immediately 
mail  or  deliver  to  the  Department  a written  ex- 
planation in  detail  of  such  inability. 

10.  The  holder  of  a Temporary  Certificate  of 
Registration  is  not  barred  thereby  from  becoming 
eligible  for  admission  to  the  Department  examina- 
tion for  a license  to  practice  medicine  in  Illinois 
if  he  otherwise  meets  the  requirements  for  ad- 
mission to  such  examination  and  if  such  person 
should  fail  to  pass  such  examination  such  failure 
shall  not  bar  him  from  completing  his  training 
program. 

Rule  IX — Limited  Licenses  to  Practice  in 
State  Hospitals 

1.  Each  application  made  on  forms  provided  by 
the  Department  will  be  considered  on  its  own 
merits. 

2.  The  State  Hospital  at  which  the  applicant 
will  practice  under  the  supervision  of  a medical 
officer,  shall  signify  to  the  Department  that  the 
hospital  will  appoint  the  applicant  in  the  event 
he  receives  a Limited  License. 

3.  Any  applicant  for  a Limited  License  who  has 
failed  in  more  than  three  examinations  for  licen- 
sure under  the  Illinois  Medical  Practice  Act  shall 
not  be  eligible  for  a Limited  License. 

ECFMG  REQUIREMENTS 

The  Education  Council  for  Foreign  Medical 
Graduates  (ECFMG)  commenced  operations  in 
October,  1957.  Sponsors  of  this  agency  are  the 
American  Hospital  Association,  American  Medical 
Association,  Association  of  American  Medical 
Colleges,  and  Federation  of  State  Medical  Boards 
of  the  United  States.  ECFMG  gives  two  examina- 
tions a year  to  foreign  medical  graduates.  The 
examinations  test  the  graduate’s  general  knowl- 
edge of  medicine  and  command  of  English. 

Persons  successfully  passing  this  examination 
are  granted  an  ECFMG  certificate.  This  certificate 


in  the  State  of  Illinois  is  not  a substitute  for 
nor  is  it  the  equivalent  of  licensure  to  practice 
medicine.  It  simply  indicates  that  the  holder’s 
command  of  English  has  been  tested  and  found 
adequate  for  assuming  an  internship  in  an  Ameri- 
can hospital.  The  holder  of  such  a certificate  may 
not  practice  medicine  in  any  degree  in  a hospital 
in  Illinois  unless  he  is  within  one  of  the  categories 
outlined  above. 

Offenses  Listed 

An  unlicensed  person  who  commits  any  of  the 
following  acts  regardless  of  whether  the  same  be 
committed  within  or  without  a hospital  is  guilty 
of  practicing  medicine  without  a license — a crimi- 
nal offense: 

1. Hold  himself  out  to  the  public  as  being  en- 
gaged in  the  diagnosis  or  treatment  of  ail- 
ments of  human  beings. 

2.  Suggest,  recommend  or  prescribe  any  form  of 
treatment  for  the  palliation,  relief  or  cure 
of  any  physical  or  mental  ailment  of  a per- 
son with  the  intention  of  receiving  therefor, 
either  directly  or  Indirectly,  any  fee,  gift,  or 
compensation  whatsoever. 

3.  Diagnosticate  or  attempt  to  diagnosticate  any 
ailment  or  supposed  ailment  of  another. 

4.  Operate  upon,  profess  to  heal,  prescribe  for, 
or  otherwise  treat  any  ailment,  or  supposed 
ailment  of  another. 

5.  Maintain  an  office  for  examination  or  treat- 
ment of  persons  afflicted,  or  alleged  or  sup- 
posed to  be  afflicted,  by  any  ailment. 

6.  Attach  the  title  Doctor,  Physician,  Surgeon, 
M.D.,  or  any  other  word  or  abbreviation  to 
his  name,  indicative  that  he  is  engaged  in 
the  treatment  of  human  ailments  as  a busi- 
ness. 

(Section  24  Medical  Practice  Act.  [Chp.  91, 

Sec.  16i,  1967  Rev.  5mi.]) 

Manifestly,  the  enforcement  of  the  Medical 
Practice  Act  with  respect  to  the  elimination  of 
unlicensed  persons  practicing  medicine  in  a hos- 
pital is  dependent  upon  co-operation  by  respon- 
sible persons  within  the  hospital.  It  should  be 
noted  that  lack  of  co-operation  or  failure  to  meet 
responsibilities  can  in  a proper  case  be  translated 
into  criminal  liability  and  disciplinary  action  re- 
sulting in  revocation  or  suspenson  of  a license  to 
practice  medicine  as  follows: 

1. The  unlicensed  person  practicing  medicine 
is  committing  a criminal  offense. 

2.  A hospital  administrator  who  assigns  an  un- 
licensed person  to  duties  which  involve  his 
practicing  medicine  may  subject  himself  to 
the  criminal  offense  of  aiding  and  abetting 
such  unlicensed  person  to  illegally  practice 
medicine,  and  the  same  may  be  true  of  a hos- 
pital chief  of  staff  or  department  head  if 
in  the  nature  of  his  duties  he  is  directly  re- 
sponsible for  assigning  such  duties  to  the  un- 
licensed person. 


for  October,  1970 


411 


3.  A licensed  doctor  may  have  his  license  sus- 
pended or  revoked  if  he  has  professional 
connection  or  association  with  another  who  is 
illegally  practicing  medicine.  A chief  of  staff 
who  knowingly  allows  such  person  to  illegally 
practice  medicine,  or  in  a proper  case,  any 
member  of  the  medical  staff  of  a hospital 
may  subject  himself  to  disciplinary  action 
against  his  license. 

4.  A licensed  doctor  may  have  his  license  sus- 
pended or  revoked  for  unethical  or  unpro- 
fessional conduct  of  a character  likely  to 
deceive,  defraud  or  harm  the  public. 

A member  of  the  medical  staff  of  a hospi- 
tal may  place  himself  within  such  conduct 
if  he  neglects,  falls  or  refuses  to  fulfill  his 
responsibilities  while  on  emergency  room 
call. 

Other  Examining  Boards 

Examining  boards  operating  under  the  jurisdic- 
tion of  the  Department  of  Registration  and  Edu- 
cation are: 

Medical  Examining  Committee 
Eugene  Hoffman,  D.C. 

William  Johnson,  M.D. 

William  McCarthy,  M.D. 

Dale  E.  Richardson,  D.O. 

Kenneth  H.  Schnepp,  M.D. 

Warren  D.  Tuttle,  M.D. 

Chiropody-Podiatry  Examining  Committee 
Dr.  Charles  H.  Delano 
Alva  J.  Harler,  D.S.C. 

Dr.  Theodore  S.  Hollingsworth 

Dental  Examining  Committee 
Dr.  Eugene  E.  Ausbrook 
Dr.  Hugh  D.  Burke 


Dr.  Ralph  H.  Council 
Dr.  Herbert  C.  Gustavson 
Dr.  Peyton  Sidney  Newwirth 
Dr.  William  Osmanski 
Dr.  Adrian  L.  Swanson 

Committee  of  Nurse  Examiners 
Sister  Mary  Francis  Cooke 
Mrs.  Donna  Hessler 
Mrs.  Ina  Ingwersen 
Mrs.  Mary  Lennan 
Mrs.  Lilliam  G.  Oertel 
Mrs.  Harriet  S.  Olson 

Optometry  Examining  Committee 
Dr.  Jose  E.  Aposte 
Dr.  Stanley  F.  Maer 
Dr.  Irving  C.  Morgan 
Dr.  Geve  Ossello 
Dr.  Floyd  Woods 

Illinois  State  Board  of  Pharmacy 
John  Barlow 
Joseph  Davidson 
Louis  Gdalman 
Fred  L.  Janes 
Daniel  Nona 
Harold  W.  Pratt 
Philip  Sacks 

Physical  Therapy  Examining  Committee 
Mr.  Robert  Babbse  Jr. 

Mr.  James  Mason  Gray 
Miss  Vilma  Evans 

Psychologist  Examining  Committee 
Dr.  Philip  Ash 
Dr.  Roy  Brener 
Dr.  Wendell  Dysinger 
Dr.  Leroy  A.  Wauk 


DEPARTMENT  OF  MENTAL  HEALTH 

401  S.  Spring  St.,  Springfield  62706 
160  N.  LaSalle  St.,  Chicago  60601 


Office  of  the  Director: 

Albert  J.  Glass,  M.D.,  Acting  Director 
John  F.  Briggs,  Deputy  Director 
E.  Kent  Ayers,  Administrative  Assistant 
Herman  E.  Heinecke,  Administrative  Assistant 
Margaret  B.  Holloway,  Administrative  Assistant 
James  Walsh,  Administrative  Assistant 
Robert  E.  Lanier,  Special  Assistant 

Research  Development  and  Training  Group: 

Peter  K.  Levison,  Ph.D.,  Manager,  Research  and 
Development 

Louis  Aarons,  Ph.D.,  Research  and  Development  Executive 

Management  Group 

Division  of  Manpower  Development 

Steve  Davis,  Chief,  Employee  Communications 

Division  of  Legislative  Liaison 

H.  Dickson  Buckley,  Manager 

Division  of  Financial  Management 
C.  R.  Crawford,  Manager 
C.  Balthazor,  Chief,  Budgetary  Services 


Frank  Campbell,  Chief,  Grants 
George  Skadden,  Chief,  Audit 
Ron  .Allen,  Acting  Chief,  Analysis  and  Evaluation 

Division  of  Community  Relations 

Richard  Burkland,  Manager 

I.  D.  Cravens,  Chief,  Public  Interest  Groups 

Bernard  McLaughlin,  Chief,  Prof’l  and  Ed’l  Facilities 

Division  of  Information  Systems 

Douglas  Hadden,  Manager 

Steve  Anderson,  Chief,  Systems  Development 

Sam  Brunk,  Chief.  Data  Services 

George  Tinsley,  Chief,  Production  Systems 

Joseph  Buckles,  Chief,  Procedures 

Division  of  Legal  Services 

Jerome  Goldberg,  Manager 

Joan  Matlaw,  Chief,  Legal  Staff 

Muriel  Lotsman,  Chief,  Interstate  Services 

Margaret  Munn,  Chief,  Hearings  and  Appeals 

William  Amling,  Chief,  Claims  Services 

Division  of  Operations  Research 

Andrew  L.  Bavas,  Manager 


412 


Illinois  Medical  Journal 


Field  Division,  Mental  Health,  Department  of 
Personnel 

John  Meyer,  Chief  Personnel  Officer 

Special  Programs 

Drug  Abuse  Programs 

Jerome  Jaile,  M.D.,  Director 

Alcoholism  Programs 

Uwe  Gunnersen,  Director 

Physical  Education  Activity  and  Recreation 

L.  Hopkins 

Communications 

R.  O.  Bacon,  Specialist 

Reiinbursement  Services 

M.  F.  Burkhardt,  Chief 

Zones  and  Institutions 

ROCKFORD:  Donald  W.  Hart,  Acting  Administrator, 
H.  Douglas  Singer 

Zone  Center,  4402  N.  Main  St.,  Rockford  61103 
H.  DOUGLAS  SINGER  ZONE  CENTER:  William  G. 
Smith,  M.D.,  Superintendent. 

CHICAGO  AREA  ZONE:  Patrick  Staunton,  M.D.,  Ad- 
ministrator, 160  N.  LaSalle  St.,  Chicago  60601 
CHICAGO/READ  MENTAL  HEALTH  CENTER: 
Francois  Alouf,  M.D.,  Superintendent,  6500  W.  Irving 
Park  Rd.,  Chicago  60634 

JOHN  J.  MADDEN  ZONE  CENTER:  Robert  deVito, 
M.D.,  Superintendent,  1200  S.  First  Ave.,  Hines  60141 
ELGIN  STATE  HOSPITAL:  Daniel  A.  Manelli,  M.D., 
Superintendent,  Elgin  60120 
MANTENO  STATE  HOSPITAL:  H.  C.  Piepenbrink, 
Superintendent,  Manteno  60950 
TINLEY  PARK  MENTAL  HEALTH  CENTER:  John 
R.  Collier,  Superintendent,  Tinley  Park  60477 

PEORLA:  Thomas  T.  Tourlentes,  M.D.,  Administrator, 
George  A.  Zeller  Zone  Center,  Peoria  61614  (address 
mail  to  Galesburg  State  Research  Hospital,  Galesburg 
61401) 

GEORGE  A.  ZELLER  ZONE  CENTER:  James  Ward, 
M.D.,  Superintendent,  5407  N.  University,  Peoria 
61614 

EAST  MOLINE  STATE  HOSPITAL:  Konstantin  Di- 
mitri, M.D.,  Superintendent,  East  Moline  61244 
GALESBURG  STATE  RESEARCH  HOSPITAL: 
Thomas  T.  Tourlentes,  M.D.,  Superintendent,  Gales- 
burg 61401 

PEORIA  STATE  HOSPITAL:  Henry  D.  Staras,  M.D., 
Superintendent,  Peoria  61607 

SPRINGFIELD:  William  H.  Anderson,  M.D.,  Administra- 
tor, Andrew  McFarland  Zone  Center,  Springfield  62707 
ANDREW  McFarland  zone  center:  Martin 
Cohen,  Ph.D.,  Superintendent,  600  Toronto  Rd., 
Springfield  62707 

JACKSONVILLE  STATE  HOSPITAL:  Charles  E.  Beck, 
M.D.,  Acting  Superintendent,  Jacksonville  62650 

DECATUR-CHAMPAIGN:  Lewis  Kurke,  M.D.,  Adminis- 
trator, Adolf  Meyer  Zone  Center,  Decatur  62526 
ADOLF  MEYER  ZONE  CENTER  (Adults):  Lewis 
Kurke,  M.D.,  Acting  Superintendent,  East  Mound  Rd., 
Decatur  62526 

HERMAN  M,  ADLER  ZONE  CENTER  (Children):  J. 
Gregory  Langan,  Ed.D.,  Superintendent,  2204  Griffith 
Dr.,  Champaign  61820 


EAST  ST.  LOUIS:  Ivan  Pavkovic,  M.D.,  Administrator, 
Office:  4500  College  Ave.,  Alton  62002 
ALTON  STATE  HOSPITAL:  Abraham  Simon,  M.D., 
Superintendent,  Alton  62002 

KANKAKEE  STATE  HOSPITAL:  Gabriel  Misevic,  M.D., 
Superintendent,  Kankakee  60901 
CARBONDALE:  Robert  C.  Steck,  M.D.,  Administrator, 
Anna  62906 

ANNA  STATE  HOSPITAL:  Robert  C.  Steck,  M.D.,  Su- 
perintendent, Anna  62906 

ILLINOIS  SECURITY  HOSPITAL:  Vernon  J.  Uffelman, 
Superintendent,  Chester  62233 

Medical  Center  Complex: 

Lester  H.  Rudy,  M.D.,  Administrator,  Medical  Center 
Complex 

INSTITUTE  FOR  JUVENILE  RESEARCH:  John  S. 
Werry,  M.D.,  Director,  907  S.  Wolcott  St.,  Chicago 
60612 

ILLINOIS  STATE  PEDIATRIC  INSTITUTE:  Herbert 
J.  Grossman,  M.D.,  Director,  1601  W.  Taylor  St., 
Chicago  60612 

ILLINOIS  STATE  PSYCHIATRIC  INSTITUTE:  Les- 
ter H.  Rudy,  M.D.,  Director,  1601  W.  Taylor  St., 
Chicago  60612 

Division  of  Mental  Retardation  Services: 

William  Sloan,  Ph.D.,  Administrator,  Springfield  62706 
Lawrence  Bussard,  Assistant  Administrator 
Charles  Jubenville,  Ed.D.,  Assistant  Administrator 
Richard  Blanton,  Ph.D.,  Assistant  Administrator 
Christian  Simonson,  Day  Care  Consultant 
fames  Howell,  Individual  Care  Grants  and  Waiting  List 
Mrs.  Ruth  Bartle,  Private  Care  Consultant 
A.  L.  BOWEN  CHILDREN’S  CENTER:  A.  J.  Shafter, 
Ph.D.,  Superintendent,  Harrisburg  62946 
DIXON  STATE  SCHOOL:  David  Edelson,  Superintend- 
ent, Dixon  61021 

WILLIAM  W.  FOX  CHILDREN’S  CENTER:  Thomas 
P.  Crane,  M.D.,  Superintendent,  Dwight  60420 
LINCOLN  STATE  SCHOOL:  Louis  Belinson,  M.D.,  Su 
perintendent,  Lincoln  62656 

WARREN  G.  MURRAY  CHILDREN’S  CENTER:  Fred 
A.  McCormack,  Superintendent,  Centralia  62801 

STATUTORY  BOARDS  AND  COUNCILS 

1.  Mental  Health  Commission 

Honorable  Esther  Saperstein,  Chicago,  Chairman 
Honorable  Hellmut  W.  Stolle,  Chicago,  Vice-Chairman 
Honorable  Frank  M,  Ozinga,  Evergreen  Park,  Executive 
Secretary 

Honorable  Joseph  J.  Karsowski,  Chicago 
Honorable  (Mrs.)  Robert  C.  Dyer,  Hinsdale 
Honorable  Sam  M.  Vadalabene,  Edwardsville 
'vVilliam  H.  Haines,  M.D.,  Chicago 
Ben  A.  Sears,  Northbrook 
Mrs,  Elizabeth  Ferry,  Decatur 
Ex  Officio— Albert  J.  Glass,  M.D.,  Acting  Director, 
Department  of  Mental  Health 

2.  Board  of  Mental  Health  Commissioners 

George  Borden,  M.D.,  Quincy 
.Alex  Elson,  Chicago 
IVillard  King,  Chicago 
(3  vacancies) 

3.  Mental  Health  Planning  Board 

Edward  A.  Piszczek,  M.D.,  Forest  Park,  Chairman 
Honorable  Harris  W.  Fawell,  Naperville 


for  October,  1970 


413 


Honorable  Esther  Saperstein,  Chicago 

Honorable  Robert  S.  Juckette,  Sr.,  Park  Ridge 

Honorable  Harold  A.  Katz,  Glencoe 

Donald  J.  Caseley,  M.D.,  Chicago 

Paul  Fromm,  Chicago 

Commissioner  Lewis  W.  Hill,  Chicago 

Jay  Hirsch,  M.D.,  Chicago 

^Villiam  H.  Ireland.  Springfield 

LeRoy  Levitt,  M.D.,  Chicago 

Robert  L.  McFarland,  Ph.D.,  Chicago 

Robert  S.  Mendelsohn,  M.D.,  Evanston 

A.  Bond  Woodruff,  Ph.D.,  DeKalb 

Ex  Officio— Director,  Department  of  Mental  Health; 
Chairman,  Board  of  Mental  Health  Commissioners; 
Chairmen  of  Council  of  Universities,  Professional  So- 
cieties and  State  and  Federal  Agencies  of  the  Board; 
Director,  Division  of  Planning  and  Evaluation 
Mrs.  Paulette  Hartrich,  Executive  Secretary 

4.  Board  of  Reimbursement  Appeals 

Ben  W.  Gordon,  DeKalb,  Chairman 
Harold  Meitus,  Chicago 
Richard  L.  Thies,  Urbana 

5.  Psychiatric  Advisory  Council 

Roy  R.  Grinker,  Sr.,  M.D.,  Chicago,  Chairman 
H.  H.  Garner,  M.D.,  Chicago,  Vice-Chairman 
Daniel  X.  Freedman,  M.D.,  Chicago 
Gerhart  Piers,  M.D.,  Chicago 
Melvin  Sabshin,  M.D.,  Chicago 
Lester  H.  Rudy,  M.D.,  Chicago 
Jackson  Smith,  M.D.,  Hines 
Harold  M.  Visotsky,  M.D.,  Chicago 

Ex  Officio— Albert  J.  Glass,  Acting  Director,  Department 
of  Mental  Health 

6.  Advisory  Council — PL  88-164 — Construction 

Grants 

Francis  J.  Gerty,  M.D.,  Forest  Park,  Chairman 

Franklin  D.  Yoder,  M.D.,  Springfield 

Edward  T.  Weaver,  Springfield 

Alfred  Sheer,  Springfield 

Harold  O.  Swank,  Springfield 

David  Donald,  Springfield 

Henry  S.  Monroe,  Winnetka 

George  K.  Hendrix,  Springfield 

David  M.  Kinzer,  Chicago 

Hiram  Sibley,  Chicago 

Mrs.  Bernice  T.  Van  der  Vries,  Evanston 

Robert  A.  Henderson,  Ed.D.,  Urbana 

Donald  J.  Caseley,  M.D.,  Chicago 

Donald  II.  Moss,  Chicago 

Mrs.  John  T.  Even,  Aurora 

John  K.  Cox,  Bloomington 

E.  D.  Stoetzel,  Washington 

Very  Rev.  Msgr.  James  V.  Moscow,  Chicago 

Mrs.  Elbert  Tourangeau,  Hinsdale 

John  H.  Geiger,  Des  Plaines 

Thomas  J.  Nayder,  Chicago 


NON-STATUTORY  BOARD, 
COMMITTEES  AND  COUNCILS 

1.  Advisory  Board — Section  on  Alcoholism  Programs 

George  Tim  Herrmann,  Chicago,  Chairman 
James  West,  M.D.,  Evergreen  Park,  Vice-Chairman 
Nelson  Bradley,  M.D.,  Park  Ridge 
Walter  F.  Kelley,  Esq.,  Chicago 
Larry  E.  Klinger,  Chicago 

File  Rt.  Rev.  Msgr.  Ignatius  McDermott,  Chicago 
The  Honorable  Henry  W.  McGee,  Chicago 
Paul  B.  Musgrove,  Peoria 
James  H.  Oughton,  Jr.,  Dwight 
Guy  Renzaglia,  Ph.D.,  Carbondale 
Honorable  .Arthur  A.  Telcser,  Chicago 
Steve  Foxx,  Chicago 
Joseph  Thurston,  Chicago 

2.  Advisory  Committee  on  Community  Menial  Health 

Grants 

Mrs.  Bernice  T.  Van  der  Vries,  Evanston,  Chairman 

Rt.  Rev.  Msgr.  William  J.  Cassin,  Springfield 

John  Chapin,  Springfield 

O.  M.  Chute,  Ed.D.,  Evanston 

Robert  L.  Farwell,  Chicago 

Honorable  Seely  P.  Forbes,  Rockford 

VTrnon  F.  Frazee,  Lincolnwood 

Rabbi  Joseph  L.  Ginsberg,  Highland  Park 

Mrs.  Francis  Lickfield,  Peoria 

.Mrs.  June  B.  McNally,  Chicago 

.Mrs.  Gordon  L.  Monsen,  Barrington 

David  P.  Richerson,  M.D.,  Johnston  City 

Mrs.  H.  Langdon  Robinson,  Springfield 

Groves  B.  Smith,  M.D.,  Alton 

Narcotics  Advisory  Council 

■Albert  J.  Glass,  M.D.,  Chicago,  Chairman 
Honorable  Arthur  A.  Telcser,  Chicago,  Vice-Chairman 
John  B.  .Acheson,  Chicago,  Executive  Secretary 
Herbert  D.  Brown,  Springfield 
Franklin  D.  A'oder,  M.D.,  Springfield 
Alfred  Sheer,  Springfield 
Flarold  O.  Swank,  Springfield 
Judge  Kenneth  Wendt,  Chicago 
Edward  T.  Weaver,  Springfield 
James  B.  Conlisk,  Jr.,  Chicago 
Commissioner  Murray  C.  Brown,  M.D.,  Chicago 
Honorable  John  Merlo,  Chicago 
Honorable  David  C.  Shapiro,  M.D.,  Amboy 
Honoralrle  Charles  Chew,  Jr.,  Chicago 
Honorable  Arthur  R.  Swanson,  Chicago 
Kermit  T.  Mehlinger,  M.D.,  Chicago 
George  Pontikes,  Chicago 
Joseph  H.  Skom,  M.D.,  Chicago 
Nicholas  Zagone,  Chicago 
Daniel  X.  Freedman,  M.D.,  Chicago 
(2  vacancies) 

James  Moran,  Secretary 


414 


Illinois  Medical  Journal 


ILLINOIS  REGIONAL  MEDICAL  PROGRAM 
REGIONAL  ADVISORY  COMMITTEE 


The  Regional  Medical  Program  for  Heart  Dis- 
ease, Cancer,  Stroke  and  Related  Diseases  was 
established  by  Congress  in  1965  as  Public  Law 
89-239.  The  Illinois  Regional  Medical  Program, 
which  began  in  1967,  is  now  incorporated  by 
the  seven  Illinois  medical  schools,  the  Chicago 
College  of  Osteopathic  Medicine,  and  their  ma- 
jor teaching  hospitals.  The  Program  seeks  to  im- 
prove patient  care  by  closing  the  gap  between  sci- 

Regional  Advisory  Group 

Dexter  Nelson,  M.D.,  Princeton,  Chairman 
Marshall  O.  Alexander,  M.D.,  Rockford,  Co-Vice 
Chairman 

Caesar  Portes,  M.D.,  Chicago,  Co-Vice  Chairman 

Leonidas  H.  Berry,  M.D.,  Chicago 

Henry  B.  Betts,  M.D.,  Chicago 

Charles  D.  Branch,  M.D.,  Peoria 

Murray  Brown,  M.D.,  Chicago 

Rev.  Curtis  Burrell,  Chicago 

Edward  W.  Cannady,  M.D.,  East  St.  Louis 

Donald  J.  Caseley,  M.D.,  Chicago 

Louis  deBoer,  Chicago 

Miss  Vilma  Evans,  Danville 

Miss  Cecelia  Fennessy,  R.N.,  Chicago 

lohn  Grede,  Ph.D.,  Chicago 

William  J.  Greek,  D.D.S.,  Springfield 

Arthur  L.  Grist,  Edwardsville 

William  J.  Grove,  M.D.,  Chicago 


ence  and  service.  It  encourages  the  establishment 
of  voluntary  cooperative  arrangements  among  var- 
ious health-related  organizations,  agencies,  and  in- 
stitutions in  the  region.  An  Advisory  Group  repre- 
sentative of  the  region  gives  overall  guidance 
to  the  Program  as  required  by  law.  It  must  ap- 
prove all  project  applications  submitted  for 
funding. 

Emanuel  Hallowitz,  Chicago 
Ronald  G.  Hansen,  Ph.D.,  Caibondale 
Clifford  Hathaway,  Peoria 
Allen  Kelly,  Eldorado 
Mrs.  Marian  Lamet,  Warsaw 
Theodore  K.  Lawless,  M.D.,  Chicago 
August  P.  Lemberger,  Ph.D.,  Chicago 
LeRoy  P.  Levitt,  M.D.,  Chicago 
Henderson  May,  Springfield 
Oglesby  Paul,  M.D.,  Chicago 
lames  W.  Phillips,  Chicago 
Will  Rasmussen,  Chicago 

David  P.  Richerson,  M.D.,  M.P.H.,  Johnston  City 

Robert  L.  Schmitz,  M.D.,  Chicago 

Rev.  Reuben  A.  Sheares,  Chicago 

Hiram  Sibley,  Chicago 

Harold  A.  Sofield,  M.D.,  Chicago 

Gail  L.  Warden,  Chicago 

Franklin  D.  Yoder,  M.D.,  Springfield 


DEPARTMENT  OF  PUBLIC  HEALTH 

535  West  Jefferson  St.,  Springfield  62706 
Franklin  D.  Yoder,  M.D.,  M.P.H.,  Director 
E.  L.  Wittenborn,  M.P.H.,  Assistant  to  the  Director 


Office  of  Health  Planning 

Clifton  L.  Reeder,  M.D. 
Consultant  to  the  Director 


Bureau  of  Personal  anti  Community  Health 

R.  F.  Sondag,  M.D.,  M.P.H.,  Chief 
Divisions  of : 

Chronic  Illness— R.  F.  Sondag,  M.D.,  M.P.H.,  Acting 
Chief 

Dental  Health-Carl  L.  Sebelius,  D.D.S.,  M.P.H.,  Chief 
Disease  Control— Norman  J.  Rose,  M.D.,  M.P.H.,  Chief 
Family  Health— James  P.  Paulissen,  M.D.,  M.P.H.,  Chief 
Health  Facilities— R.  F.  Sondag,  M.D.,  M.P.H.,  Acting 
Chief 

Nursing— Grace  Musselman,  R.N.,  M.P.H.,  Acting  Chief 

Bureau  of  General  Administration 

E.  L.  Wittenborn,  M.P.H.,  Chief 

Divisions  of : 

Accounting  and  Einance— Walter  DeWeese,  Chief 
Administration— E.  L.  Wittenborn,  M.P.H.,  .Acting  Chief 


Data  Processing— Isabelle  Crawford,  M..A.,  Chief; 

Leonard  Kutilek,  A.B.,  Acting  Chief 
Information  and  Education— Lynford  L.  Keyes,  M.P.H, 
Chief 

Local  Health  .Administration— Charles  F.  Sutton,  M.D. 
M.P.H.,  Chief 

Personnel— Dorothy  Friedman,  Chief 
Public  Health  Laboratory— Richard  A.  Morrissey, 
M.P.H.,  Chief; 

Robert  M.  Scott,  M.S.,  Assistant  Chief 

Bureau  of  Environmental  Health 

Verdun  Randolph,  M.P.H.,  Chief 
Divisions  of : 

Food  and  Drugs— Roy  W.  Upham,  D,V.M,,  M.S.,  Chief 
General  Sanitation— H.  A.  Frederick,  R.S.,  Ghief 
Milk  Control— Enos  G.  Huffer,  B.S.,  Chief 
Radiological  Health— Leroy  Stratton,  M.P.H.,  Chief 
Sanitary  Laboratory— Vacant 

Swimming  Pools  and  Beach  Sanitation— William  M. 
Honsa,  Chief 


for  October,  1970 


415 


Regional  Offices: 

Region  1 : 

E.  L.  Sederlin,  M.D.,  Health  Officer,  306  West  Main 
Street,  Carbondale  62901.  Counties  of  Hamilton  and 
Perry  and  consultation  to  full-time  health  departments 
of  Egyptian  (Gallatin-Saline-White),  Franklin-William- 
son,  Jackson,  Quadri-County  (Hardin-Johnson-Massac- 
Pope),  Randolph,  Tri-County  (Alexander-Pulaski- 
Union). 

Region  II: 

E.  E.  Diddams,  M.S.P.H.,  Acting  Health  Officer,  9500 
Collinsville  Road,  Unit  E.,  Collinsville,  62234.  Coun- 
ties of  Clinton,  Crawford,  Edwards,  Fayette,  Jasper,  Jef- 
ferson, Madison,  Marion,  Richland,  St.  Clair,  Wabash, 
Washington,  and  Wayne  and  consultation  to  full-time 
health  departments:  Counties— Bond,  Clay,  Lawrence 
and  Monroe:  Urban— East  Side  Health  District  (Can- 
teen-Centreville-East  St.  Louis-Stites  Townships). 

Region  III: 

Evelyn  M.  Cunningham,  R.N.,  Acting  Health  Officer, 
Room  173,  State  Regional  Office  Building,  4500  South 
Sixth  Street  Road,  Springfield  62706.  Counties  of  Brown, 
Cass,  Hancock,  Logan,  Macoupin,  Mason,  Sangamon, 
Schuyler,  and  Scott  Counties  and  consultation  to  full- 
time health  departments:  Counties— Adams,  Calhoun, 
Christian,  Greene,  Jersey,  Menard,  Montgomery,  Mor- 
gan, and  Pike. 

Region  IV : 

Marie  A.  Gronlund,  R.N.,  Acting  Health  Officer,  2125 


South  First  Street,  Champaign,  Illinois  61820.  Counties 
of  Champaign,  Clark,  Coles,  Cumberland,  Edgar,  Ford, 
Kankakee  and  Moultrie  and  consultation  to  full-time 
health  departments:  Counties— DeWitt-Piatt,  Douglas, 
Effingham,  Iroquois,  Livingston,  Macon,  McLean,  Shelby, 
and  Vermilion;  Urban— Champaign-Urbana  Public 
Health  District. 

Region  V : 

Arthur  E.  Sulek,  M.D.,  M.I.H.,  Acting  Health  Officer, 
5415  North  LTniversity  Avenue,  Peoria  61614.  Counties 
of  Bureau,  Henderson,  Knox,  Marshall,  McDonough, 
Putnam,  Stark,  Tazewell,  Warren,  and  Woodford  and 
consultation  to  full-time  health  departments:  Counties 
—Fulton,  Henry,  Mercer,  Peoria  and  Rock  Island;  City 
—Peoria. 

Region  VI; 

Arthur  E.  Sulek,  M.D.,  M.I.H.,  Health  Officer,  4302 
North  Main  Street,  Rockford,  61103.  Counties  of  Boone, 
LaSalle  and  Ogle  and  consultation  to  full-time  health 
departments:  Counties— Carroll,  DeKalb,  JoDaviess,  Lee, 
Stephenson,  IVhiteside  and  IVinnebago;  Urban— Hygienic 
Institute  (LaSalle,  Oglesby,  Peru)  and  Rockford. 

Region  VII: 

George  H.  Agate,  M.D.,  M.S.P.H.,  Health  Officer,  48 
IVest  Galena  Boulevard,  Aurora  60504.  Kane  County 
and  consultation  to  full-time  health  departments: 
Counties— Cook,  DuPage,  Grundy,  Kendall,  Lake,  Mc- 
Henry and  Will;  Urban— Berwyn  Township  Public 
Health  District,  Evanston-North  Shore,  Oak  Park,  Sko- 
kie, Stickney  Township  Public  Health  District. 


County  and  Multiple-County  Health  Departments 


Adams  County,  Wayne  Messick,  M.P.H.,  Public  Health 
Administrator,  333  N.  6th,  Quincy  62301 
Bond  County,  Mrs.  Carole  Bone,  R.N.,  Acting  Administra- 
tor, 100  N.  Locust,  Greenville  62246 
Calhoun  County,  Mrs.  Margaret  Hillen,  R.N.,  Acting  Ad- 
ministrator, Hardin  62047 

Carroll  County,  Mrs.  Donna  Shank,  R.N.,  Acting  Admin- 
istrator, Mt.  Carroll  61053 

Christian  County,  Clara  J.  Beaty,  R.N.,  Acting  Adminis- 
trator, Court  House,  Taylorville  62568 
Clay  County,  Mrs.  Patricia  L.  Borah,  R.N.,  Acting  Ad- 
ministrator, 1041/4  W.  Second  St.,  Flora  62839 
Cook  County.  John^B.  Hall,  M.D.,  M.P.H.,  Director.  1425 
S.  Racine  Ave.,  Chicago  60608 
North  District,  1401  Oakton  St.,  Des  Plaines  60018 
South  District  51  E.  154  St.,  Harvey  60426 
Southwest  District,  5410  W.  95th  St.,  Oak  Lawn  60453 
IVest  District,  1907-09  Rice  St.,  Melrose  Park  60160 
DeKalb  County,  Mrs.  Audre  Anderson,  R.N.,  B.S.,  Acting 
Administrator,  1731  Sycamore  Rd.,  DeKalb  60115 
DeWitt-Piatt  Bi-County,  Lelia  V.  Hyde.  R.N.,  Acting  Di- 
rector, 122  E.  Main  St.,  Clinton  61727 
Piatt  County  Office,  Courthouse,  Monticello  61856 
Douglas  County,  Mary  Lou  Pflum,  R.N.,  B.S.N.,  Acting 
Administrator,  P.O.  Box  382,  Tuscola  61953 
DuPage  County,  Charles  A.  Lang,  M.D.,  M.P.H.,  Health 
Officer,  222  E.  Willow  Ave.,  Wheaton  60187 
Effingham  County,  Peter  C.  Supan,  M.D.,  M.P.H.,  Health 
Officer,  112  E,  Section  Ave.,  Effingham  62401 
Egyptian  (Gallatin-Saline-White  Counties),  Allen  Kelly, 


B.S.,  .Acting  Administrator,  1333  Locust  St.  Eldorado 
62930 

White  County,  208  N.  Church,  Carmi  62821 
Gallatin  County,  Courthouse.  Shawneetown  62984 
FranklinAVilliamson  Bi-County,  David  P.  Richerson,  M.D., 
M.P.H.,  Health  Officer,  217  E.  Broadway,  Johnston  City 
62951 

Franklin  County,  P.O.  Box  461,  226  N.  Main,  Benton 
62812 

Fulton  County,  Gordon  J.  Poquette,  M.P.H.,  Public 
Health  Administrator,  31  S.  Main  St.,  Canton  61520 
Greene  County,  Mrs.  Barbara  Cook,  R.N.,  Acting  Admin- 
istrator. 229  N.  Fifth  St.,  Carrollton  62016 
Grundy  County,  Mrs.  Mary  C.  Reed,  R.N.,  B.S.,  Acting 
■Administrator,  1340  Edwards  St.,  Morris  60450 
Henry  County,  Grace  Van  Vooren,  R.N.,  Acting  Admin- 
istrator, Court  House  Annex,  Cambridge  61238 
Iroquois  County,  Mrs.  Ruth  Orr,  R.N.,  Acting  Admin- 
istrator, County  Court  House,  Watseka  60970 
Jackson  County,  Mrs.  Kathleen  B.  Bahn,  R.N.,  M.S.,  Act- 
ing Health  Officer,  10151/2  Chestnut  St.,  Murphysboro 
62966 

Jersey  County,  Mrs.  Nola  Kramer,  R.N.,  Acting  Admin- 
istrator, Court  House,  P.O.  Box  69,  Jerseyville  62052 
Jo  Davie.ss  County,  Marco  D.  Monti,  M.P.H.,  Public 
Health  .Administrator,  311  S.  Main  St.,  Galena  61036 
Kendall  County,  Mrs.  Mary  Ann  Klis,  R.N.,  Acting  Ad- 
ministrator, 203  Fox  Rd.,  Yorkville  60560 
Lake  County,  Jack  Irwin  Smith,  M.D.,  Dr.  P.H.,  Director, 
1515  AVashington  St.,  Waukegan  60085 


416 


Illinois  Medical  Journal 


Division  of  Nursing  (Sub-Office),  330  N.  Milwaukee 
Ave.,  Libertyville  60048 

Lawrence  County,  Maxine  Jackman,  R.N.,  Acting  Director, 
Court  House,  Lawrenceville  62439 
Lee  County,  E.  S.  Parmenter,  M.D.,  Health  Officer,  316 
W.  Third  St.,  Dixon  61021 

Livingston  County,  Mrs.  Ann  M.  Lavin,  R.N.,  Acting  Ad- 
ministrator, Rm.  418,  Bank  of  Pontiac  Bldg.,  Pontiac 
61764 

Macon  County,  Leo  Michl,  Jr.,  M.S.,  Public  Health  Ad- 
ministrator, 1085  S.  Main  St.,  Decatur  62521 
McHenry  County,  Ward  C.  Duel,  M.P.H.,  Administrator, 
209  N.  Benton  St.,  Woodstock  60098 
McLean  County,  R.  E.  Baxter,  M.D.,  Acting  Medical  Di- 
rector, 401  W.  Virginia  Ave.,  Normal  61761 
Menard  County,  Mrs.  Marjorie  White,  R.N.,  Acting  Ad- 
ministrator, Court  House,  Petersburg  62675 
(Mailing  Address)  P.O.  Box  394  Petersburg  62675 
Mercer  County,  Open,  Acting  Administrator,  Court  House, 
Aledo  61231 

Monroe  County,  Open,  Acting  Administrator,  116  W.  Mill 
St.,  Waterloo  62298 

Montgomery  County,  Willis  L.  Whitlock,  Acting  Health 
Officer,  Box  149,  Hillsboro  62049 
Morgan  County,  William  D.  Meyer,  B.S.,  Acting  Admin- 
istrator, 234(4  W.  State  St.,  Jacksonville  62650 
Peoria  County,  Clifford  Harlan,  Acting  Director  of 
Health,  2114  N.  Sheridan  Rd.,  Peoria  61604 


Pike  County,  Mrs.  Martha  Lowry,  R.N.,  Acting  Adminis- 
trator, 216  N.  Monroe,  Pittsfield  62362 
Quadri-County  (Hardin-Johnson-Massac-Pope  Counties), 
William  Hensley,  Acting  Administrator,  Box  437,  Gol- 
conda  62938 

Massac  County  Office,  Courthouse,  P.O.  Box  133,  Me- 
tropolis 62960 

Johnson  County  Office,  Vienna  62995 
Hardin  County  Office,  Gross  Bldg.,  Elizabethtown  62931 
Randolph  County,  Mrs.  Marilynn  Murphy,  R.N.,  B.A., 
Acting  Administrator,  110  W.  Jackson  St.,  Sparta  62286 
Rock  Island  County,  Fred  J.  Siebenmann,  Jr.,  B.S.,  Public 
Health  Administrator,  Court  House,  Rock  Island  61201 
Shelby  County,  Peter  C.  Supan,  M.D.,  M.P.H.,  Health 
Officer,  123  N.  Broadway,  Shelbyville  62565 
Stephenson  County,  Mrs.  Fern  M.  Brown,  R.N.,  Acting 
Administrator,  12  N.  Galena  Ave.,  Freeport  61032 
Tri-County  (Alexander-Pulaski-Union  Counties),  Ralph 
K.  Gibson,  R.P.E.,  Administrator,  529  Cross  St.,  P.O. 
Box  553,  Cairo  62914 

Vermilion  County,  Gale  Fella,  B.S.,  M.P.H.,  Public 
Health  Administrator,  808  N.  Logan,  Danville  61833 
Whiteside  County,  Mrs.  Romona  Stene,  R.N.,  Acting  Ad- 
ministrator, 201  W.  First  St.,  Rock  Falls,  61071 
Will  County.  Herbert  S.  Miller,  M.D.,  M.P.H.,  Health 
Officer,  501  Ella  .Avenue,  Joliet  60433 
Winnebago  County,  Robert  H.  Anderson,  Acting  Health 
Officer,  425  W.  State  St.,  Rockford  61101 


URBAN  HEALTH  DEPARTMENTS 


Berwyn  Health  Department,  Joseph  L.  Hrdina,  M.D., 
Health  Officer,  6600  W.  26th  St.,  Berwyn,  60402 
Champaign— Urbana  Public  Health  District.  Open,  Public 
Health  Director,  505  S.  Fifth  St.,  Champaign  61820 
Chicago  Board  of  Health,  Murray  C.  Brown,  M.D.,  Com- 
missioner of  Health,  Chicago  Civic  Center,  Room  219, 
Jack  Zackler,  M.D.,  Assistant  Commissioner  of  Health, 
Room  218,  Edward  F.  King,  R.S.,  Assistant  Commis- 
sioner of  Health,  Room  221,  Chicago  60602 
East  Side  Health  District  (Canteen-Centreville-East  St, 
Louis-Sites  Townships),  John  J.  Gregowicz,  M.D.,  Acting 
Public  Health  Director,  638  N.  20th  St.,  East  St.  Louis 
62205 

Evanston-North  Shore  Health  Department,  Allan  A.  Filek, 


M.D.,  M.S.P.H.,  Public  Health  Director,  Box  870,  Evans- 
ton 60204 

Hygienic  Institute  (LaSalle-Oglesby-Peru),  Arlington  Ailes, 
M.D.,  M.P.H.,  Director,  LaSalle  61301 
Oak  Park  Department  of  Public  Health,  Herbert  Ratner, 
M.D.,  Public  Health  Director,  Box  31,  Oak  Park  60303 
Peoria  Department  of  Health,  Clifford  Harlan,  Acting 
Director  of  Health,  2116  N.  Sheridan  Rd.,  Peoria  61604 
Rockford  Department  of  Public  Health,  Arlo  J.  Anderson, 
B.S.,  Acting  Commissioner  of  Health,  City  Hall  Bldg., 
Rockford  61104 

Skokie  Health  Department,  Samuel  L.  Andelman,  M.D., 
M.P.H.,  Director  of  Health,  8031  Floral  St.,  Skokie  60076 
Stickney  Township  Public  Health  District,  Gene  J.  Fran- 
chi,  D.D.S.,  M.P.H.,  Acting  Public  Health  Director, 
5635  State  Rd.,  Oaklawn  P.O.,  60459 


STATUTORY  BOARDS  AND  COMMISSIONS 

(Allied  with  Public  Health  Operations) 


Illinois  Legislative  Commission  on  Atomic 

Energy 

Ex-Officio 

Director  of  Agriculture 

Director  of  Business  & Economic  Development 
Director  of  Mental  Health 
Director  of  Labor 


Director  of  Public  Health 
Director  of  Civil  Defense 
Chairman  of  Commerce  Commission 
Chairman,  Pollution  Control  Board 
Director,  Law  Enforcement 
Senate  Members 

Senator  Thomas  A.  McGloon 


for  October,  1970 


417 


Senator  Robert  W.  Mitchler 
House  Members 

Representative  Samuel  C.  Maragos 
Representative  Lewis  V.  Morgan,  Jr., 
Co-Chairman 

Robert  J.  Hasterlik,  M.D.,  Co-Chairman 
William  H.  Perkins,  Jr. 

Allen  M.  Hallene,  Moline 
Dr.  Roger  Harvey,  Chicago 
Murray  Joslin,  Elmwood  Park 
Carl  W.  Larson,  Wayne 
Francis  X.  McCartin,  Oak  Lawn 
Dr.  John  H.  Rust,  Chicago 
John  F.  Ryan,  Westchester 
Alice  Phillips,  Executive  Secretary 

Cancer  Advisory  Board 

Caesar  Portes,  M.D.,  Chicago 
David  F.  Rendleman,  M.D.,  Carbondale 
James  D.  Majarakis,  M.D.,  Chicago 
J.  Ernest  Breed,  M.D.,  Chicago 
Edward  F.  Scanlon,  M.D.,  Evanston 
Harry  W.  Southwick,  M.D.,  Kenilworth 
Alfred  Kiessel,  M.D.,  Decatur 

Advisory  Board  of  Necropsy  Service  to  Coroners 

Grant  C.  Johnson,  M.D.,  Springfield,  Chairman 

Edwin  F.  Hirsch,  M.D.,  Chicago 

Rep.  Bernard  McDevitt,  Chicago 

Jacob  E.  Reisch,  M.D.,  Springfield 

James  Ryan,  M.D.,  Kankakee 

W.  E.  (Barney)  West,  Tamaroa 

Guy  R.  Williams,  Jr.,  Havana 

Roger  B.  Ytterberg,  Springfield 

Horace  H.  Payton,  Peoria 

Advisory  Nursing  Homes  and  Homes  for  the 
Aged  Council 

Franklin  D.  Yoder,  M.D.,  Springfield,  Chairman 

Joseph  Patton,  Springfield 

Robert  Wessel,  Springfield 

Larry  E.  Klapmeier,  DeKalb 

William  Deems,  Lawrenceville 

P.  V.  Dilts,  M.D.,  Springfield 

Steven  Sargent,  Springfield 

Jeanette  R.  Kramer,  Palatine 

Mrs.  Gunhild  McAllister,  R.N.,  Forest  Park 

Russell  Moline,  Evanston 

Joseph  P.  Welch,  Barrington 

John  H.  Coggeshall,  Belleville 

Advisory  Committee  for  Heritable  Metabolic 
Diseases 

Ralph  Kunstadter,  M.D.,  Chicago,  Chainnan 

Stanley  Berlow,  M.D.,  Chicago 

Joseph  D.  Boggs,  M.D.,  Chicago 

Mrs.  Arlene  K.  Burroughs,  Chicago 

Joseph  P.  Greer,  Chicago 

Herbert  Grossman,  M.D.,  Chicago 

John  B.  Hall,  M.D.,  Chicago 


David  Y.  Hsia,  M.D.,  Chicago 
Joseph  Kraft,  M.D.,  Chicago 
Mrs.  Carol  H.  Preucil,  Chicago 
Miss  Bernadine  Robb,  Chicago 
Ira  Rosenthal,  M.D.,  Chicago 

Advisory  Hospital  Council 

Franklin  D.  Yoder,  M.D.,  Springfield,  Chairman 
Representatives  of  Public  Agencies 
Robert  E.  Lanier,  Springfield  (Mental  Health) 
Henry  A.  Holle,  M.D.,  Chicago  (Public  Aid) 
Odin  Anderson,  Chicago 
Francis  E.  Bihss,  M.D.,  East  St.  Louis 
Everett  Coleman,  M.D.,  Canton 
Raymond  A.  Dougherty,  M.D.,  Mattoon 
Leonard  P.  Goudy,  Peoria 
George  K.  Hendrix,  Springfield 
Francis  Hickey,  Rockford 
David  M.  Kinzer,  Chicago 
W.  Henderson  May,  Springfield 
Harris  Perlstein,  Chicago 
Paul  Plunkett,  Wilmette 
Lee  Pravatiner,  Chicago 
Mrs.  Louis  Rubin,  Rockford 
Willard  C.  Scrivner,  M.D.,  East  St.  Louis 
H.  Clay  Tate,  Bloomington 
Edward  C.  Thompson,  D.D.S.,  Urbana 
Rev.  John  Weisnar,  Peoria 
William  R.  Williams,  Hinsdale 
Mrs.  Ann  Zercher,  Lincolnwood 

Clinical  Laboratory  and  Blood  Bank  Advisory 
Board 

James  B.  Hartney,  M.D.,  Oak  Park,  Chairman 
Herbert  Dexheimer,  M.D.,  Belleville 
Robert  K.  Fiersten,  Springfield 
Hugh  J.  McDonald,  Sc.D.,  Skokie 

D.  Robert  Thornburg,  Wilmette 
Paul  Van  Pernis,  M.D.,  Rockford 

Hospital  Licensing  Board 

George  K.  Hendrix,  Springfield,  Chairman 

William  Lees,  M.D.,  Lincolnwood 

Sue  Kern,  R.N.,  Chicago 

Elmer  E.  Abrahamson,  Chicago 

Jack  B.  Edmundson,  Carbondale 

F.  Merrill  Lindsay,  Jr.,  Decatur 

Rt.  Rev.  Msgr.  Clement  Schindler,  Belleville 

Emil  O.  Stahlhut,  Lincoln 

Theodore  R.  Van  Dellen,  M.D.,  Chicago 

Board  of  Public  Health  Advisors 

E.  A.  Piszczek,  M.D.,  Forest  Park,  Chairman 
Elmer  Beadles,  D.D.S.,  Ashland 

Bernard  E.  Bolotoff,  M.D.,  Rockford 
Carl  A.  Brandy,  D.V.M.,  Urbana 
August  F.  Daro,  M.D.,  Chicago 
Robert  G.  Kesel,  D.D.S.,  Chicago 
Mrs.  F.  W.  Specht,  Wheaton 
Alex  Van  Praag,  Decatur 


418 


Illinois  Medical  Journal 


Migrant  Labor  Advisory  Coniniittee 

Phillip  Ccllins,  Morris 

Harold  Hartley,  Centralia 

Miss  Naomi  Hiett,  Springfield 

W.  D.  Jones,  Streator 

Walter  S.  Sass,  Chicago 

Dean  Sears,  Bloomington 

Ohio  River  Valley  Water  Sanitation 
Commission 

Clarence  W.  Klassen,  Springfield 
Franklin  D.  Yoder,  M.D.,  Springfield 
John  E.  Pearson,  Champaign 

Radiation  Protection  Advisory  Council 

Roger  A.  Harvey,  M.D.,  Chicago  Chairman 

L.  H.  Lanzl,  Ph.D.,  Chicago 

Frank  E.  Demaree,  Lake  Forest 

Joseph  V.  Link,  D.D.S.,  Springfield 

Robert  J.  Hasterlik,  M.D.,  Chicago 

John  E.  Rose,  Sc.D.,  Argonne 

Barney  J.  Grabiec,  Ex-Officio 

David  H.  Armstrone,  Springfield,  Ex-Officio 

Illinois  Chronic  Renal  Disease 
Advisory  Committee 

Franklin  D.  Yoder,  M.D.,  Springfield,  Chairman 
Arthur  E.  Abney,  Chicago 
Allan  A.  Filek,  M.D.,  Evanston 
Henry  P.  Banser,  Jr.,  Addison 


Hayes  Beall,  Chicago 
Dr.  David  P.  Earle,  Chicago 
Dr.  H.  B.  Henkel,  Jr.,  Springfield 
Dr.  Alan  Kanter,  Chicago 
Dr.  Robert  M.  Kark,  Chicago 
Rev.  Beryl  Kinser,  Springfield 
Dr.  James  D.  Myers,  Peoria 
Clarence  L.  Gantt,  M.D.,  Chicago 
Ex-Officio  members: 

Roy  W.  Brooks 
Henry  A.  Holle,  M.D. 

Mrs.  Minna  Ulhorn,  R.N. 

A.  R.  Lavender,  M.D.,  Hines 
Staff  Advisors: 

R.  F.  Sondag,  M.D. 

William  J.  Cassel,  Jr.,  M.D. 

linmuni7:ation  Advisory  Commiltee 

Ralph  Kunstadter,  M.D.,  Chicago,  Chairman 

John  B.  Hall,  M.D.,  Chicago 

P.  M.  Schmidt,  M.D.,  Galva 

Joseph  R.  Kraft,  M.D.,  Chicago 

David  Greeley,  M.D.,  Chicago 

Mark  Lepper,  M.D.,  Chicago 

Daniel  J.  Pachman,  M.D.,  Chicago 

Norman  Rose,  M.D.,  M.P.H.,  Tech.  Sec. 

James  P.  Paulissen,  M.D.,  Springfield,  Staff 


NON  STATUTORY  BOARDS 

(Allied  with  Public  Health  Operations) 


Clinical  Laboratory  and  Blood 
Bank  Advisory  Board 
James  B.  Hartney,  M.D.,  Chicago 
Chairman 

Herbert  P.  Dexheimer,  M.D.,  Belleville 
Hugh  J.  McDonald,  M.D.,  Maywood 
Paul  A.  Van  Pernis,  M.D.,  Rockford 
Robert  K.  Fiersten,  Springfield 
Robert  Thornburg,  M.D.,  Chicago 

Committee  for  Revision  of  the  Rules  and 
Regulations  for  the  Control  of 
Communicable  Diseases 

Norman  J.  Rose,  M.D.,  M.P.H.,  Springfield, 
Chairman 

John  B.  Hall,  M.D.,  Chicago 

Mark  Lepper,  M.D.,  Chicago 

Herbert  S.  Miller,  M.D.,  Joliet 

David  P.  Richerson,  M.D.,  Johnston  City 

Richard  A.  Morrissey,  Chicago 

James  P.  Paulissen,  M.D.,  Springfield 

Harry  Harding,  M.D.,  Evanston 

Paul  Schnurrenberger,  M.D.,  Springfield 

Colette  Rasmussen,  M.D.,  Chicago 

Olga  Brolnitsky,  M.D.,  Chicago 

Ralph  Kundstater,  M.D.,  Chicago 


Advisory  Committee  on  Hazardous  Substances 

Norman  J.  Rose,  M.D.,  M.P.H.,  Springfield, 
Chairman 

J.  R.  Christian,  M.D.,  Chicago 
Leon  Fennoy,  East  St.  Louis 
J.  H.  Hawke,  St.  Louis,  Mo. 

Robert  E.  Mason,  Jr.,  Chicago 
C.  J.  Nowak,  Chicago 
Edward  F.  O’Toole,  Chicago 
Jerry  S.  Schain,  Chicago 

Veterinary  Advisory  Board 

Paul  B.  Doby,  D.V.M.,  Springfield,  Chairman 
George  T.  Woods,  D.V.M.,  Urbana 
Wallace  E.  Brandt,  D.V.M.,  Flanagan 
Dale  Andregg,  D.V.M.,  Freeport 
Amos  P.  Wilson,  D.V.M.,  Danville 
Robert  Mahr,  D.V.M.,  Palatine 
Homer  Teegarden,  D.V.M.,  Eureka 
Leland  Holt,  D.V.M.,  Granite  City 

Grade  A Milk  Advisory  Board 

Franklin  D.  Yoder,  M.D.,  Springfield,  Chairman 

George  Baker,  Moline 

Willard  J.  Corbett,  M.D.,  Rockford 

Norman  Eisenstein,  Chicago 


for  October,  1970 


419 


Clyde  Fruit,  Edwardsville 
H.  W.  Galley,  Jr.,  Chicago 
Fletcher  Gourley,  Springfield 
Vernon  Janes,  Champaign 
Floyd  M.  Keller,  Chicago 
Lyle  Roszell,  Chicago 
Ed  Rush,  Peoria 
Paul  Scherschel,  Chicago 

L.  K.  Wallace,  Bloomington 
Raymond  Weinheimer,  Highland 
Howard  K.  Wells,  Chicago 

Advisory  Committee  for 
Regional  Medical  Programs 

Dexter  Nelson,  M.D.,  Princeton,  Chairman 

Marshall  O.  Alexander,  M.D.,  Rockford 

Leonidas  H.  Berry,  M.D.,  Chicago 

Henry  B.  Betts,  M.D.,  Chicago 

Charles  D.  Branch,  M.D.,  Peoria 

Edward  W.  Cannady,  M.D.,  East  St.  Louis 

Donald  J.  Caseley,  M.D.,  Chicago 

Cecelia  Fennessey,  R.N.,  Chicago 

William  J.  Greek,  D.D.S.,  Springfield 

Arthur  Grist,  Edwardsville 

William  J.  Grove,  M.D.,  Chicago 

Ronald  G.  Hansen,  Ph.D.,  Carbondale 

Ormand  C.  Julian,  M.D.,  Chicago 

Mrs.  Marian  Lamet,  Warsaw 

Theodore  K.  Lawless,  M.D.,  Chicago 

August  P.  Lemberger,  Ph.D.,  Chicago 

LeRoy  P.  Levitt,  M.D.,  Chicago 

Oglesby  Paul,  M.D.,  Chicago 

James  W.  Phillips,  Chicago 

Caesar  Portes,  M.D.,  Chicago 

David  P.  Richerson,  M.D.,  Johnston  City 

Robert  L.  Schmitz,  M.D.,  Chicago 

Hiram  Sibley,  Chicago 

Harold  A.  Sofield,  M.D.,  Oak  Park 

Gail  L.  Warden,  Chicago 

Franklin  D.  Yoder,  M.D.,  Springfield 

Foods  and  Dairies  Advisory  Committee 

Emmett  F.  Pearson,  M.D.,  Springfield 
Gail  M.  Dack,  Ph.D.,  M.D.,  Elgin 
Edward  King,  Chicago 

M.  G.  Van  Buskirk,  Naperville 
Dario  Toffenetti,  Chicago 
August  Van  Daele,  Hillside 
Ray  L.  Haase,  River  Forest 
Marion  B.  McClelland,  Decatur 
D.  Bruce  Hartley,  Chicago 
Eugene  Theios,  Waukegan 
Mrs.  Leufader  Walton,  Chicago 
William  F.  Rowley,  Jr.,  M.D.,  Oak  Park 

Health  Care  Facilities 
Dr.  Robert  Rutherford,  Peoria 
Health  Care  Facilities 
Joseph  Settler,  D.S.C.,  Skokie 
Environmental  Health 
Dr.  Vivien  Peers  Siegel,  East  St.  Louis 
Personal  Health  Services 


Philip  G.  Thomsen,  M.D.,  Dolton 
Personal  Health  Services 
W.  D.  Tuttle,  M.D.,  Harrisburg 

Organization  for  Community  Health  Services 
Harold  M.  Visotsky,  M.D.,  Springfield 
Health  Care  Facilities 
Mr.  William  H.  Weed,  Ottawa 
Personal  Health  Services 
Mr.  Harvey  D.  Zuckerberg,  Skokie 
Environmental  Health 

Illinois  Committee  for  Medical  Residencies 
in  Public  Health 

Charles  F.  Sutton,  M.D.,  Springfield,  Chairman 

Clifton  Hall,  M.D.,  Springfield 

John  B.  Hall,  M.D.,  Chicago 

Charles  A.  Lang,  M.D.,  Wheaton 

Mark  H.  Lepper,  M.D.,  Chicago 

Edward  A.  Piszczek,  M.D.,  Forest  Park 

Eugene  L.  Wittenborn,  M.P.H.,  Springfield 

Vlado  A.  Getting,  M.D.,  Consultant 

Illinois  Statewide  Public  Health  Committee 

David  W.  Meister,  Peoria,  Co-Chairman 
Mrs.  Pauline  Trelease,  Urbana,  Co-Chairman 

Technical  Advisory  Commitle  on  Lasers 
Isaac  D.  Abella,  Ph.D.,  Chicago 
Herman  Cember,  Ph.D.,  Evanston 
Charles  L.  Cheever,  Argonne 
Nick  Holonyak,  Jr.,  Ph.D.,  Urbana 
Clifford  E.  Mensing,  Maywood 
Frank  W.  Newell,  M.D.,  Chicago 

Advisory  Committee  on  Prevention  of 
Accidental  Poisoning  in  Children 

Norman  J.  Rose,  M.D.,  M.P.H.,  Springfield, 
Chairman 

Joseph  R.  Christian,  M.D.,  Chicago 
W.  L.  Crawford,  M.D.,  Rockford 
J.  Keller  Mack,  M.D.,  Springfield 
Paul  Pierce,  M.D.,  Alton 
John  S.  Stull,  M.D.,  Olney 
Walter  M.  Whitaker,  M.D.,  Quincy 

Statewide  Advisory  Council  to  the  Office  of 
Comprehensive  Planning  (Transferred  to  the 
Office  of  the  Governor) 

Clifton  L.  Reeder,  M.D.,  Park  Ridge,  Chairman 

Consumers 

Ellen  Bolar,  St.  Anne 

D.  Jane  Bond,  Chicago 

Paul  W.  Brandel,  Chicago 

Honorable  Robert  E.  Brinkmeier,  Forreston 

Jane  C.  Browne,  Chicago 

Lois  Buckingham,  Chicago 

Robert  J.  Dickson,  Wauconda 

John  E.  Ekblad,  Rock  Island 

Francis  Hickey,  Rockford 

Dr.  John  Jacobs,  Evanston 


420 


Illinois  Medical  Journal 


Mrs.  John  F.  Jacobs,  Springfield 
Esther  O.  Kegan,  Chicago 
Helen  Levin,  Champaign 
Robert  W.  Mitchler,  Oswego 
Earl  Moldovan,  Salem 
John  Moutoussamy,  Chicago 
Morris  E.  Nelson,  Altona 
Ross  Reardon,  Springfield 
Harold  D.  Schwartz,  Lincolnwood 
Rev.  Rudolph  Shoultz,  Springfield 
Honorable  Fred  Smith,  Chicago 
Ross  Tarr,  Peoria  Heights 
Nathan  Willens,  Skokie 
Marie  Woolen,  East  St.  Louis 

Providers 

C.  Norman  Andrews,  Chicago 
Ben  Behrent,  Pawnee 
Dr.  Ralph  E.  Dolkart,  Evanston 
Don  C.  Frey,  Evanston 


William  J.  Greek,  D.D.S.,  Springfield 
John  B.  Hall,  M.D.,  Chicago 
Jerome  Hammerman,  Chesterton 
Joseph  B.  Helms,  D.V.M.,  Edwardsville 
Dr.  Robert  R.  J.  Hilker,  Chicago 
Helen  Hotchner,  R.N.,  LaGrange 
Thaddeus  P.  Kawalek,  Chicago 
David  Kinzer,  Chicago 
Dr.  LeRoy  Levitt,  Chicago 
Dr.  Edward  Lis,  Flossmoor 
Virginia  Ohlson,  R.N.,  Chicago 
Dr.  Eric  Oldberg,  Lake  Forest 
Dr.  Edward  Perry,  Salem 
Dr.  Edward  Piszczek,  Chicago 
James  W.  Roodhouse,  East  Peoria 
Dr.  Robert  Rutherford,  Peoria 
Joseph  Settler,  D.P.M.,  Tremont 
Dr.  Vivien  P.  Siegel,  East  St.  Louis 
Philip  G.  Thomsen,  M.D.,  Dolton 
William  H.  Weed,  Ottawa 


HOSPITALS  WITH  SPECIAL  TYPE  OF  SERVICE 


CASEYVILLE  (St.  Clair) 
CHICAGO  (Cook) 


DECATUR  (Macon) 

HINSDALE  (Cook) 

JOLIET  (Will) 
MACKINAW  (Tazewell) 
MOOSEHEART  (Kane) 


Pleasant  View  Sanitorium  (E-70) 

* Booth  Memorial  Hospital  (B-19) 

*Schwab  Rehabilitation  Hospital  (B-88) 
*Chicago  Eye,  Ear,  Nose  and  Throat 
Hospital  (C-37) 

*Chicago  State  Tuberculosis 
Sanitarium  (1-346) 

*The  Children’s  Memorial 
Hospital  (B-236) 

Halco  Hospital,  Inc.  (C-10) 

*LaRabida  Jackson  Park 
Sanitarium  (B-104) 

*Martha  Washington  Hospital  (B-40) 
*Municipal  Contagious  Disease  Hospital 
(D-lOO) 

^Municipal  Tuberculosis  Sanitarium 
(D-760) 

*Rehabilitation  Institute  of  Chicago  (B-71) 
St.  Vincent’s  Infant  Hospital  (B-65) 
*Shriners  Hospital  for  Crippled 
Children  (B-68) 

Macon  County  Tuberculosis 
Sanitorium  (E-40) 

*The  Suburban  Cook  County  Tuberculosis 
Sanitarium  District  (G-209) 

Sunny  Hill  Sanitorium  (E-41) 

Oak  Knoll  Sanitorium  (E-40) 

Moosehart  Hospital  (B-43) 


Type  of 
Service 

TB 

Maternity 

Rehabilitation 

EENT 

TB 

Pediatric 

Alcoholic 

Pediatric 

Chronic 

Alcoholic 

Contagious 

Disease 

TB 

Rehabilitation 

Pediatric 

Orthopedic, 

Pediatric 

TB 

TB 

TB 

TB 

Pediatric 


for  October,  1970 


421 


MOUNT  VERNON  (Jefferson) 

♦Mount  Vernon  State 

Tuberculosis  Sanitarium  (1-125) 

TB 

OAK  FOREST  (Cook) 

Oak  Forest  Hospital  (E-2,400) 

Chronic 

OTTAWA  (LaSalle) 

♦Ottawa  General  Hospital  (C-51) 

Chronic 

PEORIA  (Peoria) 

♦Peoria  Municipal  Tuberculosis 
Sanitarium  (D-77) 

TB 

ROCKFORD  (Winnebago) 

Rockford  Municipal  Tuberculosis 
Sanitarium  (D-45) 

TB 

ROCK  ISLAND  (Rock  Island) 

♦Rock  Island  County 

Tuberculosis  Sanitorium  (E-71) 

TB 

SPRINGFIELD  (Sangamon) 

♦St.  John’s  Sanitorium  (B-50) 

TB 

URBANA  (Champaign) 

Outlook  Champaign  County 
Tuberculosis  Sanitorium  (E-25) 

TB 

WAUKEGAN  (Lake) 

♦Lake  County  Tuberculosis 
Sanatorium  (E-90) 

TB 

WEDRON  (LaSalle) 

St.  Joseph’s  Health  Resort 
and  Sanitarium  (B-94) 

Medical- 

Chronic 

Number  in  parenthesis  indicates  number  of 
beds  in  hospital.  Initial  preceding  number  refers 
to  the  type  of  control,  as  follows: 

A — Corporation 

B — Non-profit  association  or  corporation 
C — Privately  owned  and  operated 


D — City 
E — County 
F — Hospital  District 
G — Sanitarium  District 
H — Township 
I — State 
J — Federal 


*Medicare  Certified 


STATE  MENTAL  HOSPITALS 


ALTON  (Madison) 

Alton  State  Hospital  (1,216) 

ANNA  (Union) 

Anna  State  Hospital  (1,206) 

CHICAGO  (Cook) 

Chicago  State  Hospital  (1,958) 

♦Illinois  State  Psychiatric  Institute  (310) 
EAST  MOLINE  (Rock  Island) 

♦East  Moline  State  Hospital  (1,255) 

ELGIN  (Kane) 

Elgin  State  Hospital  (4,128) 

GALESBURG  (Knox) 

♦Galesburg  State  Research  Hospital  (1,481) 


JACKSONVILLE  (Morgan) 

♦Jacksonville  State  Hospital  (1,305) 
KANKAKEE  (Kankakee) 

♦Kankakee  State  Hospital  (2,561) 
MANTENO  (Kankakee) 

Manteno  State  Hospital  (5,907) 
MENARD  (Randolph) 

Illinois  Security  Hospital  (260) 
PEORIA  (Peoria) 

♦Peoria  State  Hospital  (1,545) 

TINLEY  PARK  (Cook) 

Tinley  Park  Mental  Health  Center  (523) 


PRIVATE  MENTAL  HOSPITALS 


AURORA  (Kane) 

♦Mercyville  Institute  of  Mental  Health  (B-120) 
CHICAGO  (Cook) 

♦Fairview  Hospital  (C-100) 

♦Nicholas  J.  Pritzker  Center  (B-40) 

♦Pinel  Hospital  Inc.  (B-70) 

♦Ridgeway  Hospital  (B-99) 


DES  PLAINES  (Cook) 

♦Forest  Hospital  (C-105) 
ELGIN  (Kane) 

♦Resthaven  Hospital  (C-100) 
FOREST  PARK  (Cook) 
♦Riveredge  (C-145) 


422 


Illinois  Medical  Journal 


STATE  SCHOOLS  FOR  MENTALLY  RETARDED 


CENTRALIA  (Marion) 

Warren  G.  Murray  Children’s  Center  (700) 
CHICAGO  (Cook) 

*Illinois  State  Pediatric  Institute  (264) 
DIXON  (Lee) 

Dixon  State  School  (4,245) 


DWIGHT  (Livingston) 

William  W.  Fox  Children’s  Center  (250) 
HARRISBURG  (Saline) 

A.  L.  Bowen  Children’s  Center  (244) 
LINCOLN  (Logan) 

Lincoln  State  School  (4,819) 


LICENSED  CLINICAL  LABORATORIES 


ALTON 

Stromsdorfer  Medical  Laboratory 
604  E.  Broadway,  Rm.  101  62002 

ARCOLA 

Oak  Park  Medical  Laboratory 
207  East  Main  61910 

ARGO 

*Argo  Clinical  Laboratory 
6252  Archer  Road  60501 

ARLINGTON  HEIGHTS 

‘Village  Medical  Laboratory 
1009  S.  Evergreen  60005 

‘Arlington  Medical  Laboratory 

1430  N.  Arlington  Heights  Road  60004 

AURORA 

‘Clinical  Laboratory 

143  South  Lincoln  60505 

Physicians  Clinical  Laboratory 
57  E.  Downer  Place  60504 

BARRINGTON 

‘Barrington  Medical  Laboratory 
606  S.  Northwest  Hwy.  60010 

BELLEVILLE 

‘St.  Clair  Medical  Laboratory 
301  W.  Lincoln  Street  62221 

BENTON 

Benton  Medical  Center  Laboratory 
205  Bailey  Lane  62812 

BERKELEY,  CALIFORNIA 

Solano  Laboratories— Clinical  Laboratory  Affiliates 
2113  Dwight  Way  94701 

BERWYN 

Cermak  Road  Medical  Laboratories 
7120  W.  Cermak  Road  60402 

‘Kenilworth  Laboratory 

6905-A  West  Cermak  Road  60402 

Public  Health  District,  Town  of  Berwyn 
6600-26th  Street  60402 

Stickney  Township  Public  Health  Laboratory 
6721  West  40th  Street  60402 

BLOOMINGTON 

‘Bloomington  Cornbelt  Bio-Chemical,  Inc. 

705  North  East  61701 

Clinical  and  Surgical  Pathology  Laboratory 
211  E.  Jefferson  St.  61701 


Medical  Arts  Building  Laboratory 
2304  E.  Oakland  Ave.  61701 
E.  M.  Stevenson,  M.D.  Laboratory 
Suite  418  Unity  Bldg.  61701 
‘Hans  H.  Stroink,  M.D.  Clinical  Laboratory 
214  Unity  Building  61701 

BROADVIEW 

‘Broadview  Physicians  Laboratory 
2200  W.  Roosevelt  Rd.  60153 

CANTON 

Coleman  Clinic  Laboratory 
175  South  Main  61520 

CENTRALIA 

Centralia  X-ray  Laboratories 
418  South  Poplar  62801 
Medical  Arts  Laboratory,  Inc. 

210  E.  Third  Street  62801 

CHAMPAIGN 

‘Doctors  Building  Laboratory 
301  E.  Springfield  01820 

CHICAGO 

*A  & D Medical  Laboratory,  Inc. 

3848  West  63rd  Street  60629 
A-C  Medical  Laboratory 
3512  West  26th  Street  60623 
Abel  Laboratory,  Inc.— Bio-Tech. 

25  E.  Washington  St.  60602 
‘Accurate  Medical  Laboratory,  Inc. 

5959  N.  Washtenaw  Ave.  60645 
‘Almar  Clinical  Laboratory 
2457  W.  Peterson  Ave.  60645 
American  Clinical  Testing  Laboratory 
30  W.  Washington  St.  60602 
‘Apogee  Medical  Laboratories,  Inc 
5962  N.  Lincoln  Ave.  60645 
‘Arcade  Clinical  Laboratory 
6904  N.  Sheridan  Rd.  60626 
Archer  Clinical  Laboratory 
4176  Archer  60632 

‘Associated  Medical  Laboratory,  Inc. 

4753  N.  Broadway  60604 
‘Auburn  Clinical  Laboratory 
946  West  79th  Street  60620 
Augusta  Clinical  Laboratory 
3454  N.  Lincoln  Ave.  60657 
‘Austin  Clinical  Laboratory 
5679  W.  Madison  St.  60644 
‘Avenue  Medical  Laboratory 
11318  S.  Michigan  Ave.  60628 


for  October,  1970 


423 


*Bel-Aire  Medical  Building  Laboratory 
8501  S.  Cottage  Grove  Ave.  60619 
Beverly  Clinical  Laboratory 
9451  South  Hoyne  60620 
Beverly  Laboratory  Building,  Inc. 

8710  S.  Ashland  Ave.  60620 
•Beverly  Sheridan  Laboratory,  Inc. 

944914  S.  Ashland  Ave.  60620 
•Brooks  Clinical  Laboratory 

4006  Milwaukee  Avenue  60641 
•Aaron  S.  Caban,  M.D.  Laboratory 
4010  W.  Madison  Street  60624 
Callahan  Clinic  Laboratory 
4849  W.  Fullerton  Ave.  60639 
Campos  Laboratory 

1608  N.  Milwaukee  60647 
•Central  Doctors  Medical  Laboratory 
2715  N.  Central  Ave.  60639 
Central  Medical  Building  Laboratory 
3929  N.  Central  Ave.  60634 
Century  Medical  Laboratory 
8348  Stony  Island  Ave.  60617 
•Chatham  Avalon  Clinical  Laboratory 

8222  S.  Martin  Luther  King,  Jr.  Drive  60619 
•Chemical  Consulting  Corporation 
6018  W.  Fullerton  Ave.  60639 
Chicago  Board  of  Health— Division  of  Laboratories 
Lower  Level— Chicago  Civic  Center  60602 
Chicago  Park  District  Medical  Laboratory 
425  East  14th  Blvd.  60605 
Chicago  Health  Center  Laboratory 
15  S.  Wacker  Drive  60619 
Chicago  Physicians  Medical  Laboratory,  Inc. 

4555  N.  Broadway  60640 
•Clearing  Industrial  Clinic,  Inc. 

5548  W.  65th  Street  60638 
•Colonial  Medical  Arts  Laboratory 
2024  West  79th  Street  60620 
•Community  Medical  Laboratory 
3613  W.  Roosevelt  Rd.  60624 
Continental  Insurance  Company 
360  W.  Jackson  Blvd.  60606 
Corbett  Clinic  Medical  Laboratory 
1380  W.  Lake  Street  60607 
Crawford  Medical  Arts  Laboratory 
6449  S.  Pulaski  Road  60629 
Cytodiagnostic  Laboratory,  Inc. 

25  E.  Washington  60602 
Division  Medical  Laboratory,  Inc. 

2625  W.  Division  St.  60622 
Division  Clinical  Laboratory 
5025  W.  Division  St.  60651 
Doctors  Building  Laboratory 
2800  West  87th  60652 
•Doctors  Medical  Laboratory,  Inc. 

11440  S.  Michigan  Ave.  60628 
•Drexel  Home,  Inc. 

6140  S.  Drexel  Avenue  60637 
Field  Clinic  Laboratory 

4600  N.  Ravenswood  Ave.  60640 
Fordon  Medical  Laboratory 
2656  W.  63rd  Street  60629 
•Foster  Western  Laboratories,  Inc. 

5214  N.  Western  Ave.  60625 
Francis  Laboratory 

122  S.  Michigan  Ave.  60603 


•Gerber  X-Ray  and  Clinical  Laboratory 
2400  West  Devon  60645 
•Gerson  Clinical  Laboratory 
1 North  Pulaski  60625 
Grant  Hospital  Laboratory 
551  W.  Grant  Place  60614 
Greer  Clinical  Laboratories,  Inc. 

4013  N.  Milwaukee  60641 
•Highland  Medical  Laboratory 
7922  S.  Ashland  Ave.  60620 
Highland  View  Medical  Center 
8556  S.  Ashland  Ave.  60620 
•Humboldt  Clinical  Laboratory 
2018  S.  Ashland  Ave.  60608 
•Hyde  Park  Medical  Laboratory 
5240  South  Harper  60615 
Illinois  Clinical  Laboratory 
55  E.  Washington  St.  60602 
Irving  Park  Clinical  Laboratory 
3959  N.  Lincoln  Ave.  60613 
*K  & K Clinical  Laboratory 
5935  W.  Addison  60634 
•Kendon  Medical  Laboratory,  Inc. 

8625  S.  Cicero  Avenue  60658 
Laboratory  of  Linion  Health  Service 
1634  West  Polk  60612 
•Letho  Clinical  Laboratories 
1325  S.  Racine  Avenue  60608 
Logan  Square  X-Ray  and  Clinical  Laboratory,  Inc. 

2815  N.  Kimball  60618 
•Marquette  Medical  Laboratory 
6132  South  Kedzie  60629 
•Mart  X-Ray  Laboratory  Company 
7-110  Merchandise  Mart  60654 
•Maryhaven  Medical  Laboratory,  Inc. 

8700  S.  Dante  Avenue  60619 
•Mason-Barron  Pathology  Clinical  Laboratory 
2056  North  Clark  Street  60614 
•Medic  Clinical  Laboratory 

6317  S.  Western  Avenue  60636 
•Medical  Association  of  Chicago  Clinic  Laboratory 
3233  South  King  Drive  60616 
•Medical  Center  Clinical  Laboratory 
3528  N.  Ashland  Ave.  60657 
Mediscreen  Laboratory 
5 South  Wabash  60603 
•Metro  Laboratories 

1737  W.  Howard  St.  60626 
Metro  Laboratories 
9204  Commercial  Ave.  60617 
•Metro  Laboratories 

2376  E.  71st  Street  60649 
Metro  Laboratories 

1525  E.  53rd  Street  60615 
•Metro  Laboratories 

30  N.  Michigan  Avenue  60602 
Metro  Laboratory 

104  South  Michigan  60603 
Meyer  Medical  Group 

10444  S.  Kedzie  Avenue  60655 
Meyer  Medical  Group 
653  West  79th  Street  60620 
•Midwest  Cytology  Laboratory 
5707  North  Ashland  60626 
Milwaukee  Avenue  X-Ray  and  Clinical  Laboratory 
1217  N.  Milwaukee  Ave.  60622 
•Molay  Medical  Laboratory 
185  North  Wabash  60601 


424 


Illinois  Medical  Journal 


*Murphy  Uptown  Clinical  Laboratory,  Inc. 

4753  North  Broadway  60640 
‘North  Kimball  Medical  Laboratory 
1579  N.  Milwaukee  Ave.  60622 
Northwest  Medical  Laboratory 
2006  West  Chicago  60622 
Norwest  Medical  Laboratory 
2336  West  Chicago  60622 
‘Ogden  Hill  Medical  Laboratory 
3451  West  63rd  Street  60629 
‘Omens  Medical  Building  X-Ray  and  Clinical 
Laboratory 

5720  West  North  Avenue  60639 
*P.  M.  D.  Clinical  Laboratory 
2017  West  95th  Street  60643 
‘Park  View  Home  Medical  Laboratory 
1401  N.  California  60622 
‘Park-Grove  Medical  Laboratory 
8048  S.  Cottage  Grove  60619 
Parke  DeWatt  Laboratories,  Inc. 

Ill  North  Wabash  Ave.  60602 
Parkside  Clinical  Laboratory 
7915  S.  King  Drive  60619 
•Parkway  Laboratory 

408  E.  Marquette  Road  60637 
•Pasco  Medical  Laboratories 
55  E.  Washington  St.  60602 
‘Peterson  Western  Clinical  Laboratory 
2424  West  Peterson  60645 
‘Physicians  and  Surgeons  Laboratory 
6710  West  North  Ave.  60635 
Post  Graduate  Hospital  Laboratory 
2400  S.  Dearborn  Street  60616 
Robard  Corporation 
30  North  Michigan  60602 
•S  & S Medical  Laboratorv,  Inc. 

532  East  47th  Street  60653 
•Sarian  Medical  Laboratory 

6257  South  Archer  Ave.  60638 
‘Sauganash  X-Ray  and  Medical  Laboratory,  Inc. 

4833  W.  Peterson  60646 
‘South  Central  Medical  Laboratory 
5050  South  State  60609 
•South  East  Medical  Laboratory 
1832  East  87  th  Street  60617 
Southwestern  Laboratory,  Inc. 

7939  S.  Western  Avenue  60620 
Thompson  X-Ray  and  Clinical  Laboratory 
1150  North  State  Street  60610 
•Thornburg  Clinical  Laboratory 
841  East  63rd  Street  60637 
•Thornburg  Clinical  Laboratory 
720  N.  Michigan  Ave.  60611 
Richard  W.  Tiecke,  D.D.S. 

211  E.  Chicago  Avenue  60611 
United  Air  Lines  Medical  Department 
P.O.  Box  66100  60666 
‘United  Medical  Laboratories,  Inc. 

8 S.  Michigan  Ave.,  Room  1412  60603 
‘University  Laboratory 

5 South  Wabash  Avenue  60603 
•West  Lawn  Medical  Laboratory 
4255  West  63rd  Street  60629 
‘Westerly  Medical  Laboratory 
10404  South  Western  60643 
•Westridge  Clinical  Laboratory 
6450  N.  California  60645 


‘Westside  Clinical  Laboratory 
3808  W.  Roosevelt  Rd.  60624 
•Zeitlin  X-Ray  and  Clinical  Laboratory 
2800  Milwaukee  Avenue  60618 
‘200  Clinical  Laboratory 
200  East  75th  Street  60619 
*2011  Clinical  Laboratory,  Inc. 

2011  East  75  th  Street  60649 
*63rd  Medical  Laboratory 
749  West  63rd  Street  60621 
*95th  Street  X-Ray  and  Clinical  Laboratory 
243  West  95th  Street  60628 
United  Airlines  Medical  Department  Laboratory 
O'Hare  Field  Station,  Box  66140  60666 

CICERO 

‘Suburban  Laboratory,  Inc. 

2137  S.  Lombard  Avenue  60650 

COLLINSVILLE 

Appleton  Laboratory 
416  E.  Main  Street  62201 

DEKALB 

DeGraffenried  and  Fisher 
720  Haish  Boulevard  60115 
‘DeGraffenried  Fisher  Laboratory 
1838  Sycamore  Road  60115 
DeKalb  Medical  Center  Laboratory 
901  North  First  Street  60115 

DECATUR 

‘Central  Clinical  Laboratory 
1314  North  Main  62526 
Macon  County  Health  Department  Laboratory 
1085  South  Main  Street  62521 

DEERFIELD 

‘Colrad  Clinical  Laboratory 
747  Deerfield  Road  60614 

DES  PLAINES 

‘Dempster-Lyman  Clinical  Laboratory  and  X-Ray 
2404  Dempster  60016 
‘Deridge  Clinical  Laboratory 
3200  Dempster  Street  60016 
Fahey  Medical  Center 
581  Golf  Road  60016 

DETROIT,  MIGHIGAN 
Central  Laboratories,  Inc. 

312  David  ^Vhitney  Bldg.  48226 

DIXON 

‘Physicians  Medical  Laboratory 
101  West  First  Street  61021 

DOWNERS  GROVE 

Downers  Grove  Medical  Laboratory 
4333  Main  Street  60515 
DuPage  Medical  and  Research  Laboratory 
1043  Curtiss  60515 

EAST  ST.  LOUIS 
‘Appleton  Laboratory 

234  Collinsville  Ave.  62201 
‘Clinical  Laboratory 

4601  State  Street  62201 


for  October,  1970 


425 


ELGIN 

•Fox  Valley  Medical  Laboratory 
860  E.  Summit  Street  60120 

ELK  GROVE  VILLAGE 

Medical  Laboratory  and  X-Ray,  Inc. 

762  Arlington  Hts.  Rd.  60007 

ELMHURST 

Cytopathology  Laboratory 
135  S.  Kenilworth  60126 
•Haven  Clinical  Laboratory 
103  Haven  Road  60126 
Pasco  Medical  Laboratory 
533  W.  North  Avenue  60126 
•Sandahl  Medical  Laboratory 
135  S.  Kenilworth  60126 

EVANSTON 

•Cos  Building  Laboratory 
2500  Ridge  Avenue  60201 
•Gyne-Cytology  Laboratory,  Inc. 

636  Church  Street  60201 
•Pasco  Medical  Laboratories 
636  Church  Street  60201 
Evanston-North  Shore  Health  Dept. 

Box  870  60201 

EVERGREEN  PARK 
•Acorn  Laboratories 

2658  West  95th  Street  60642 
•Anatomic  and  Clinical  Pathology 
P.O.  Box  42919  60642 
Evergreen  Park  Medical  Laboratory 
9760  South  Kedzie  Ave.  60642 
•Francisco  Medical  Laboratory 
9450  S.  Francisco  Ave.  60642 
Mosquera  Clinical  Laboratory 
3830  West  95th  Street  60642 
•North  Beverly  Clinical  Laboratory 
3759  West  95  th  Street  60642 

FOREST  PARK 
•Bowers  Laboratory 

7318  Madison  Street  60130 

FRANKLIN  PARK 

•Franklin  Park  Medical  Laboratory,  Inc. 

9711  Grand  60131 

FREEPORT 

Freeport  Clinic  Laboratory 
222  W.  Exchange  Street  61032 
Freeport  Medical  Clinic 
324  West  Galena  61032 
Northwest  Illinois  Laboratory 

319  North  West  Avenue  61032 

GALESBURG 

•Galesburg  Clinic  Laboratory 

320  N.  Kellogg  Street  61401 

GLEN  ELLYN 

Glen  Ellyn  Clinic  Laboratory 
454  Pennsylvania  Avenue  60137 
Glen  Ellyn  Medical  Laboratory 
526  Crescent  Boulevard  60137 

GLENVIEW 

•Northwest  Suburban  X-Ray  and  Clinical  Laboratory 
924  Waukegan  Road  60025 


GODFREY 

Doctors  Laboratory 

1312  West  Delmar  62035 

HARVEY 

Community  Medical  Center 
15900  Carol  Avenue  60426 
•Graham  Clinical  Laboratory 
468  East  147th  Street  60426 

Weiss  Clinical  Laboratory 
15318  Center  Avenue  60426 

HIGHLAND  PARK 
•Highland  Park  Medical  Laboratory 
1950  Sheridan  Road  60035 

HINSDALE 

•Pasco  Medical  Laboratories 
40  South  Clay  Street  60521 

HOFFMAN  ESTATES 
•Twinbrook  Medical  Laboratory 
Golf  & Roselle  Road  60172 

JACKSONVILLE 

Medical  Development  Corporation 
1440  West  Walnut  62650 

JERSEYVILLE 

J.  R.  Miller  Medical  Laboratory 
123A  West  Pearl  Street  62052 

JOLIET 

•Associate  Pathologists 

2112  West  Jefferson  60435 
•Central  Laboratory 

57  W.  Jefferson  Street  60431 

Joliet  Clinical  Laboratory 
59  W.  Clinton  Street  60431 
•Osier  Laboratories,  Inc. 

120  North  Scott  Street  60431 

•Prescription  Shop  Laboratory 
55  N.  Ottawa  Street  60431 
•Woodruff  Laboratory,  Inc. 

250  N.  Ottawa  Street  60431 

KANKAKEE 

•Medical  Center  Laboratory 
1309  East  Court  Street  60901 

Physicians  Medical  Laboratory,  Inc. 

555  S.  Schuyler  Avenue  60901 

LAGRANGE 

•LaGrange  Medical  Building  Laboratory 
47  South  Sixth  60525 

LAGRANGE  PARK 

Village  Market  Medical  Laboratorv 
360  Sherwood  Court  60525 

LASALLE 

Hygienic  Institute  Laboratory 
151  Fifth  Street  61301 
•Medical  Laboratory 
555-2nd  Street  61301 

LANSING 

•DeGraff  Clinical  Laboratory 
3341  Ridge  Road  60438 

LEROY 

V.  K.  Pliura,  M.D.  Laboratory 
101  West  School  61752 

LOMBARD 

Lombard  Chiropractic  Clinical  Laboratory 
200  E.  Roosevelt  Road  60148 


42') 


Illinois  Medical  Journal 


MACOMB 

McDonough  District  Hospital  Laboratory 
525  East  Grant  Street  61455 

MARSEILLES 
Carr  Medical  Laboratory 
Main  Street  61341 

MAYWOOD 

*Joslyn  Clinic  Laboratory 

1908  St.  Charles  Road  60153 

MC  HENRY 

*McHenry  Medical  Group 
1110  N.  Green  Street  60050 

MELROSE  PARK 
Broadway  Medical  Laboratory,  Inc. 

1812  North  Broadway  60160 
*Delm  Medical  Laboratory 
1900  West  Iowa  60160 

MENDOTA 

Mendota  Community  Hospital  Laboratory 
Memorial  Drive  61342 

MOLINE 

*Martin  Clinical  Laboratory 
1520-7th  Street  61265 
Moline  Public  Hospital  Laboratory 
635-lOth  Avenue  61265 

MORRISTOWN,  NEW  JERSEY 
Bio-Analytical  Associates,  Inc. 

36  Elm  Street  07960 

MORTON  GROVE 
♦Sommerfeld  Medical  Laboratory,  Inc. 

5818  Dempster  Street  60053 

MOUNT  PROSPECT 
*Mount  Prospect  Clinical  Laboratory 
321  West  Prospect  Ave.  60056 
•Prospect  Clinical  Laboratory 

1060  W.  Northwest  Hwy.  60056 
Professional  Arts  Medical  Laboratory 
221  West  Prospect  60056 

MUNDELEIN 

Menolasino  Laboratory,  Inc. 

1352  Armour  Boulevard  60060 

NORTHBROOK 

Industrial  Bio-Test  Laboratories,  Inc. 

1810  N.  Frontage  Road  60062 
•Northbrook  Clinical  and  X-Ray  Laboratory 
1775  Walters  60062 

OAK  LAWN 

Stickney  Township  Public  Health  Laboratory 
5635  State  Road  60459 

OAK  PARK 

•American  Medical  Laboratory 
6441  W.  North  Avenue  60302 
•Arms  Medical  Laboratory 

414  S.  Oak  Park  Avenue  60302 
•James  B.  Hartney,  M.D. 

410  Lake  Street  60302 
•McGregor  Laboratory 

6144  W.  Roosevelt  Road  60304 


Medical  Arts  Clinic  Laboratory 
715  Lake  Street  60301 

Tarlow  Clinical  Laboratory 
6525  W.  North  Avenue  60302 
•Hill  Clinical  Laboratory,  Inc. 

1011  Lake  Street  60301 

OAKBROOK 

•Pasco  Medical  Laboratories 

120  Oak  Brook  Ctr.  Mall  60521 

OGLESBY 

•Physicians  Clinical  Laboratory 
338  East  Walnut  61348 

OLYMPIA  FIELDS 

Athenia  Park  Medical  and  X-Ray  Laboratory 
2601  W.  Lincoln  Hwy.  60461 

PALOS  HEIGHTS 
•Palos  Medical  Laboratory 

12150  S.  Harlem  Avenue  60463 

PARK  FOREST 

Medical  and  Dental  Building  Clinical  Laboratory 
23450  S.  Western  Avenue  60466 
•South  Suburban  Medical  Laboratory 
2448  Western  Avenue  60466 

PARK  RIDGE 

Park  Ridge  Clinical  Laboratory 
3 South  Prospect  Ave.  60068 

Plaza  Laboratories  Ltd. 

101  S.  Washington  St.  60068 

PEKIN 

•Medical  Laboratory,  The 
519  Margaret  61554 

PEORIA 

*M.  B.  Clinical  Laboratory  Corp. 

818  West  Main  61606 
•Medical  Center  Laboratories 
416  St.  Marks  Court  61603 

Peoria  Department  of  Health 
2116  N.  Sheridan  Road  61604 
•W.  H.  Schwarzendruber  Laboratory 
300  E.  IVar  Memorial  Dr.  61614 

ROCKFORD 

•Medical  Laboratory  of  Pathology 
1221  E.  State  Street  61108 

Rockford  Health  Department  Laboratory 
425  E.  State  Street  61104 

ROLLING  MEADOWS 

Rolling  Meadows  Professional  Laboratory 
3407  Kirchoff  Road  60008 

ROSELLE 

Sylvester  Clinical  Laboratory 
225  E.  Irving  Park  Road  60172 

SANDWICH 

Sandwich  Comm.  Hospital  Laboratory 
11  East  Pleasant  60548 

SKOKIE 

Harry  H.  Hetz,  M.D.  Pathology  Laboratories 
4240  Dempster  Street  60076 
•Lincoln  Medical  Laboratory 
4535  Oakton  Street  60076 


for  October,  1970 


42.1 


4801  Church  Street  60076 
♦Pasco  Medical  Laboratories 
64  Old  Orchard  60076 

SPRINGFIELD 
♦Capitol  Clinical  Laboratories 
1104  South  2nd  Street  62704 
Doctors  Park  Medical  Laboratory 
701  North  Walnut  62702 
♦Physicians  Medical  Laboratory 
501  N.  6th-Box  2178  62703 
♦Springfield  Clinic 

1025  South  7th  Street  62703 

STREATOR 

Streator  Medical  Clinic 
Westgate  Plaza  61364 

SUMMIT 

Dwan  Medical  Center  Laboratory 
7450  West  63rd  Street  60501 


♦Besley-Waukegan  Clinic 

215  N.  Sheridan  Road  60085 

♦Physicians  and  Surgeons  Laboratory 
1616  Grand  Avenue  60085 
Standard  Bio-Medical  Laboratories,  Inc. 

521  Greenwood  Avenue  60085 
X-Ray  and  Clinical  Laboratory 
4 South  Genesee  60085 

WESTCHESTER 
Westchester  Community  Clinic 
1938  S.  Mannheim  60153 

WHEATON 

♦Mason-Barron  Pathology  Laboratory 
200  E.  Willow  60187 

WILMETTE 

♦Wilmette  Clinical  Laboratory 
165  Green  Bay  Road  60091 


SYCAMORE 

DeGralTenried  and  Fisher 
Sycamore  Municipal  Hosp.  60178 


WILMINGTON 
Clinical  Laboratory  and  X-Ray 
107  S.  Water  Street  60481 


URBANA 

Carle  Clinic  Laboratory 
602  W.  University  61801 

VILLA  PARK 
♦Ardmore  Pharmacy,  Inc. 

317  S.  Ardmore  60181 
Villa  Medical  Arts  Laboratory 
10  E.  Central  Blvd.  60181 


WINNETKA 

♦Clinical-Technical  Laboratory,  Inc. 

1048  Gage  Street  60093 
♦Winnetka  Clinical  Laboratory 
725  Elm  Street  60093 

ZION 

♦Zion  Clinic  Laboratory 

2629  Sheridan  Road  60099 
♦Medicate  Certified. 


APPROVED  CHRONIC  RENAL 

Michael  Reese  Hospital  and  Medical  Center 
29th  Street  and  Ellis  Avenue 
Chicago,  Illinois  60616 
Dr.  Alan  Kanter 
Presbyterian-St.  Luke’s  Hospital 
1753  West  Congress  Parkway 
Chicago,  Illinois  60612 
Dr.  Franklin  D.  Schwartz 
Washington  University  School  of  Medicine 
(Barnes  Hospital) 

660  South  Euclid  Avenue 
St.  Louis,  Missouri  63110 
Dr.  Neal  S.  Bricker 
Memorial  Hospital 
Renal  Unit 

First  and  Miller  Streets 
Springfield,  Illinois  62701 
Dr.  Alton  Morris 
St.  Francis  Hospital 
523  Northeast  Glen  Oak 
Peoria,  Illinois  61603 
Dr.  James  D.  Myers 
University  of  Illinois  Research 
and  Educational  Hospitals 
840  South  Wood  Street 
Chicago,  Illinois  60612 
Dr.  Clarence  L.  Gantt 
Passavant  Memorial  Hospital 
303  East  Superior  Street 
Chicago,  Illinois  60611 
Dr.  Francesco  del  Greco 


DIALYSIS  CENTERS  AND  DIRECTORS 

Mount  Sinai  Hospital  Medical  Center 
Fifteenth  and  California  Avenues 
Chicago,  Illinois  60608 
Dr.  George  Dunea 

University  of  Chicago  Hospitals  and  Clinics 
(includes  LaRabida  Sanitarium) 

950  East  59th  Street 
Chicago,  Illinois  60637 

Dr.  Frank  P.  Stuart  and  Dr.  Adrian  I.  Katz 

West  Suburban  Hospital 

518  North  Austin  Boulevard 

Oak  Park,  Illinois  60302 

Dr.  Robert  C.  Muehrcke 

University  Hospitals  Renal  Section 

Department  of  Medicine 

1300  University  Avenue 

Madison,  Wisconsin  53706 

Dr.  Arvin  B.  Weinstein 

Evanston  Hospital 

2650  Ridge  Avenue 

Evanston,  Illinois  60201 

Dr.  Bernard  Adelson 

West  Suburban  Kidney  Center,  S.C. 

1011  Lake  Street 
Room  410 

Oak  Park,  Illinois  60301 
Dr.  Robert  C.  Muehrcke 
Rockford  Memorial  Hospital 
2300  N.  Rockton  Avenue 
Rockford,  Illinois 
Di.  Ewald  T.  Sorensen 


428 


Illinois  Medical  Journal 


APPROVED  CHRONIC  RENAL 

The  Children’s  Memorial  Hospital 
2300  Children’s  Plaza 
Chicago,  Illinois  60614 
Dr.  Gilbert  Given 

Rockford  Memorial  Hospital 
2300  North  Rockton  Avenue 
Rockford,  Illinois 
Ewald  T.  Sorensen,  M.D. 

Galesburg  Cottage  Hospital 
674  North  Seminary  Street 
Galesburg,  Illinois  61401 
Dr.  Agha  Babanoury 


DIALYSIS  UNITS  AND  DIRECTORS 

Used  as  a satellite  by  Centers: 

Freeport  Clinic 
222  West  Exchange  Street 
Freeport,  Illinois  61032 
Dr.  Thomas  A.  Haymond 

For  further  information  contact: 

Mrs.  Ruth  S.  Shriner,  ACSW 
Illinois  Department  of  Public  Health 
535  West  Jefferson  Street 
Springfield,  Illinois  62706 
Phone:  (217)  525-6564 


ARTIFICIAL  KIDNEY  CENTERS 

As  of  Aug.  7,  1969,  these  centers  may  be  contacted  regarding  renal  dialysis. 


Children’s  Memorial  Hospital 

Phone:  348-4040 

2300  Children’s  Plaza 

Person  in  Charge: 

Alan  Siegel,  M.D. 

Chicago 

Location  in  Hosp: 

Nephrology 

Edgewater  Hospital 

Phone:  UP  8-6000 

5700  N.  Ashland  Avenue 

Person  in  Charge: 

Rogelio  Riera,  M.D. 

Chicago 

Location  in  Hosp: 

Surgery 

Michael  Reese  Hospital 

Phone:  791-2000 

2929  South  Ellis  Avenue 

Person  in  Charge: 

Dr.  Allan  Kanter 

Chicago 

Location  in  Hosp: 

Department  of  Medicine 

Mt.  Sinai  Hospital 

Phone:  277-4000 

Division  of  Renal  Medicine 

California  Ave.  at  15th  Street 

Person  in  Charge: 

Dr.  George  Dunea 

Chicago 

Location  in  Hosp: 

Department  of  Medicine 

Passavant  Memorial  Hospital 

Phone:  WH  4-4200 

303  E.  Superior  Street 

Person  in  Charge: 

Francesco  del  Greco,  M.D. 

Chicago 

Location  in  Hosp: 

Artificial  Kidney 

Presbyterian-St.  Lukes  Hospital 

Phone:  942-5000 

1753  West  Congress  Parkway 

Person  in  Charge: 

Robert  M.  Kark,  M.D. 

Chicago 

Location  in  Hosp: 

Division  of  Medicine 

University  of  Chicago  Hospital 

Phone:  MU  4-6100 

Dr.  Frank  P.  Stuart  and 

950  E.  59th  Street 

Persons  in  Charge: 

Dr.  Adrian  Katz 

Chicago 

Location  in  Hosp: 

Department  of  Medicine 

University  of  IIli.\ois  Research 
and  Educational  Hospital 

Phone:  663-7591 

840  South  Wood  Street 

Person  in  Charge: 

Clarence  Gantt,  M.D. 

Chicago 

Location  in  Hosp: 

Clinical  Research  Center 

St.  Joseph  Hospital 

Phone:  741-5400 

277  Jefferson  Avenue 

Person  in  Charge: 

Charles  K.  Bobelis,  M.D. 

Elgin 

Location  in  Hosp: 

Artificial  Kidney  Dept. 

Evanston  Hospital 

Phone:  492-2000 

2650  Ridge  Avenue 

Person  in  Charge: 

Dr.  Bernard  Adelson 

Evanston 

Location  in  Hosp: 

Kidney  Dialysis  Dept. 

Galesburg  Cottage  Hospital 

Phone:  343-4121 

674  N.  Seminary  Street 

Person  in  Charge: 

Agha  Babanoury,  M.D. 

Galesburg 
Riverside  Hospital 

Phone:  933-1671 

350  N.  Wall 

Person  in  Charge: 

Dr.  Eugene  Anderson 

Kankakee 

Location  in  Hosp: 

Intensive  Care 

West  Suburban  Hospital 

Phone:  EU  3-6200 

518  North  Austin  Boulevard 

Person  in  Charge: 

Robert  Muehrcke,  M.D. 

Oak  Park 

I.ocation  in  Hosp: 

Kidney  Dialysis  Room-2nd  FI. 

for  October,  1970 


429 


St.  Francis  Hospital 

Phone: 

674-7731 

Ext.  605 

530  N.E.  Glen  Oak 

Person  in  Charge: 

Dr.  J.  D.  Myers 

Peoria 

Location  in  Hosp: 

Chronic  Dialysis  Unit 

Rockford  Memorial  Hospital 

Phone: 

968-6861 

2300  N.  Rockton  Avenue 
Rockford,  Illinois 

Person  in  Charge: 

Dr.  Ewald  T.  Sorensen 

Swedish-American  Hospital 

Phone: 

968-6898 

1316  Charles  Street 

Person  in  Charge: 

Dr.  Robert  Henry 

Rockford 

Location  in  Hosp: 

Intensive  Care 

Memorial  Hospital 

Phone 

528-2041 

First  & Miller  Streets 

Person  in  Charge: 

Dr.  Alton  Morris 

Springfield 

Location  in  Hosp: 

Intensive  Care 

Barnes  Hospital 

Phone: 

367-6400 

Barnes  Hospital  Plaza 

Person  in  Charge: 

Neal  Bricker,  M.D. 

St.  Louis,  Missouri 

Location  in  Hosp: 

Second  Floor 

St.  Francis  Hospital 

Phone: 

334-4461 

825  Good  Hope  Street 

Person  in  Charge: 

Sister  M.  Venard 

Cape  Girardeau,  Missouri 

Location  in  Hosp: 

Surgery 

POISON  CONTROL  CENTERS  IN  ILLINOIS 

For  further  information  contact: 

Norman  J.  Rose,  M.D.,  M.P.H.,  Chief 
Bureau  of  Hazardous  Substances  and  Poison 
Control 

Illinois  Department  of  Public  Health 
535  W.  Jefferson 
Springfield  62706 
Phone:  (217)  525-7747 

AURORA 

Copley  Memorial  Hospital 
Lincoln  & Weston  Avenues 

896- 461  1,  Ext.  725 
St.  Charles  Hospital 

400  E.  New  York  Street 

897- 8714,  Ext.  50 

BELLEVILLE 
Memorial  Hospital 
4501  North  Park  Dr. 

233-7750,  Ext.  250  & 251 

BELVIDERE 

Highland  Hospital 
1625  S.  State  St. 

547-5441,  Ext.  367 

BERWYN 

MacNeal  Memorial  Hospital 
3249  S.  Oak  Park  Ave. 

484-2211  Ext.  311,  312,  314 

BLOOMINGTON 
Mennonite  Hospital 
807  North  Main  St. 

828- 5241,  Ext.  311 
St.  Joseph  Hospital 

2200  E.  Washington 

829- 9481,  Ext.  352,  354 


CAIRO 

St.  Mary’s  Hospital 
2020  Cedar  St. 

734-2400,  Ext.  42,  45 

CANTON 

Graham  Hospital  Association 
210  W.  Walnut  St. 

647-5240,  Ext.  230 

CARBONDALE 

Doctors  Memorial  Hospital 
404  W.  Main  St. 

457-4101 

CARTHAGE 

Memorial  Hospital 
End  South  Adams  St. 

357-3133,  Ext.  57 

CENTRALIA 

St.  Mary’s  Hospital 
400  N.  Pleasant  Ave. 

532-6731,  Ext.  626,  629 

CHAMPAIGN 

Burnham  City  Hospital 
3 1 1 E.  Stoughton  St. 

337-2533 


430 


Illinois  Medical  Journal 


CHANUTE  AIR  FORCE  BASE* 
United  States  Air  Force  Hospital 
893-3111,  Ext.  6234 
CHESTER 

Memorial  Hospital 
1900  State  St. 

826-2367,  Ext.  44 


EAST  ST.  LOUIS 
Christian  Welfare  Hospital 
1509  Illinois  Ave. 
874-7076,  Ext.  232 
St.  Mary’s  Hospital 
129  North  8th  St. 
274-1900,  Ext.  204 


CHICAGO 

Children’s  Memorial  Hospital 
2300  Children’s  Plaza 
348-4040,  Ext.  338 
Cook  County  Hospital 
1825  West  Harrison  St. 

633-6542 

University  of  Illinois  Hospitals 
840  South  Wood  St. 

663-7297 
Mercy  Hospital 

2510  Martin  Luther  King  Dr. 

842-4700,  Ext.  281 
Michael  Reese  Hospital 
29th  Street  & Ellis  Ave. 

791-2261 

Mt.  Sinai  Hospital 
15th  & California 
277-4000,  Ext.  297 
Municipal  Contagious  Disease  San. 

3026  South  California  Ave. 

247-5700 

Presbyterian-St.  Lukes  Hospital 

(Master  Chicago  Center  for  information, 
treatment  & reference  on  poisoning) 

1753  W.  Congress  Parkway 
942-5969 

Resurrection  Hospital 
7435  West  Talcott  Ave. 

774-8000,  Ext.  235,  236 
Wyler  Children’s  Hospital 
950  E.  59th  St. 

684-6100  Ext.  6231,  6232 

DANVILLE 

Lake  View  Memorial  Hospital 
812  N.  Logan  Ave. 

443-5221 

St.  Elizabeth  Hospital 
600  Sager  St. 

442-6300 

DECATUR 

Decatur  Memorial  Hospital 
2300  N.  Edward  St. 

877-8121,  Ext.  675-676 
St.  Mary’s  Hospital 

1800  E.  Lake  Shore  Dr. 

429-2966,  Ext.  640 

DES  PLAINES 
Holy  Family  Hospital 
100  North  River  Road 
299-2281,  Ext.  856 

♦Limited  for  treatment  of  military  personnel  and 

families,  except  for  indicated  emergencies. 


EFFINGHAM 

St.  Anthony’s  Memorial  Hospital 
503  North  Maple  St. 

342- 2121,  Ext.  67 

ELGIN 

St.  Joseph’s  Hospital 
277  Jefferson  Ave. 

741- 5400,  Ext.  65,  69 
Sherman  Hospital 

934  Center  St. 

742- 9800,  Ext.  682 

ELMHURST 

Memorial  Hospital  of  Du  Page  County 
315  Schiller  St. 

833-1400,  Ext.  551,  552 

EVANSTON 

Community  Hospital 
2040  Brown  Ave. 

869-5044,  Ext.  54,  58 
Evanston  Hospital 
2650  Ridge  Ave. 

492-6460 

St.  Francis  Hospital 
355  Ridge  Ave. 

492-2440 

EVERGREEN  PARK 

Little  Company  of  Mary  Hospital 
2800  W.  95th  St. 

422-6200,  HI5-6000,  Ext.  211 

FAIRBURY 

Fairbury  Hospital 
519  South  Fifth  St. 

692-2346 

FREEPORT 

Freeport  Memorial  Hospital 
420  South  Harlem  Ave. 

233-4131,  Ext.  228 

GALENA 

The  Galena  Hospital  District 
Summit  Street 
777-1340 

GALESBURG 

Galesburg  Cottage  Hospital 
674  North  Seminary  St. 

343- 4121,  Ext.  356 
St.  Mary’s  Hospital 

239  South  Cherry  St. 

343-3161,  Ext.  210 


for  October,  1970 


431 


GRANITE  CITY 
St.  Elizabeth’s  Hospital 
2100  Madison  Ave. 

876-2020,  Ext.  224 

HARVEY 

Ingalls  Memorial  Hospital 
15510  Page  Ave. 

333-2300,  Ext.  787,  792 

HIGHLAND 
St.  Joseph  Hospital 
1515  Main  St. 

654-2171,  Ext.  243 

HIGHLAND  PARK 

Highland  Park  Hospital  Foundation 

718  Glenview  Ave. 

432-8000,  Ext.  561,  562,  563 

HINSDALE 

Hinsdale  San.  & Hospital 
120  North  Oak  St. 

323-2100,  Ext.  336 

HOOPESTON 

Hoopeston  Community  Memorial  Hospital 
701  E.  Orange 
283-5531 

JACKSONVILLE 

Passavant  Memorial  Area  Hospital 
1600  West  Walnut  St. 

245-9541,  Ext.  222 

JOLIET 

St.  Joseph’s  Hospital 
333  N.  Madison  St. 

725-7133,  Ext.  679,  680,  681,  682 
Silver  Cross  Hospital 
600  Walnut  St. 

727-1711,  Ext.  731 

KANKAKEE 
Riverside  Hospital 
350  N.  Wall  St. 

933-1671,  Ext.  606 
St.  Mary’s  Hospital 
150  South  Fifth  St. 

939-4111,  Ext.  735 

KEWANEE 

Kewanee  Public  Hospital 

719  Elliott  St. 

853-3361,  Ext.  219 

LAKE  FOREST 
Lake  Forest  Hospital 

660  North  Westmoreland  Road 
234-5600,  Ext.  608 

LASALLE 

St.  Mary’s  Hospital 
1015  O’Conor  Ave. 

223-0607 


LIBERTYVILLE 
Condell  Memorial  Hospital 
Cleveland  & Stewart  Aves. 

362-2900,  Ext.  325-326 

LINCOLN 

Abraham  Lincoln  Memorial  Hospital 
315  Eighth  St. 

732-2161,  Ext.  346 

MACOMB 

McDonough  District  Hospital 
525  East  Grant  St. 

833-4101 

MAYWOOD 

Loyola  University  Hospital 
2160  S.  1st  Ave. 

531-3886  (24-hour  direct  line) 

MATTOON 

Mem.  Dist.  Hosp.  of  Coles  County 
2101  Champaign  Ave. 

234-8881,  Ext.  43,  29 

McHENRY 
McHenry  Hospital 

3516  West  Waukegan  Road 

385-2200,  Ext.  614 

MELROSE  PARK 
Westlake  Hospital 
1225  Superior  St. 

681-3000,  Ext.  226,  239 

MENDOTA 

Mendota  Community  Hospital 
Memorial  Drive 

7461,  Ext.  20 

MOLINE 

Moline  Public  Hospital 
635-lOth  Ave. 

762-3651,  Ext.  232 

MONMOUTH 

Community  Memorial  Hospital 
W.  Harlem  Ave. 

734-3141,  Ext.  224 

MOUNT  CARMEL 
Wabash  General  Hospital 
1418  College  Drive 

262-4121,  Ext.  231 

MOUNT  VERNON 

Good  Samaritan  Hospital 
605  North  Tv/elfth  St. 

242-4600,  Ext.  303, 

NAPERVILLE 
Edward  Hospital 

South  Washington  St. 

355-0450,  Ext.  326 

NORMAL 

Brokaw  Hospital 

Virginia  at  Franklin  Ave. 

829-7685,  Ext.  274 


432 


Illinois  Medical  Journal 


OAK  LAWN 

Christ  Community  Hospital 
4440  West  95th  St. 

423-7000,  Ext.  659,  600,  661 

OAK  PARK 

West  Suburban  Hospital 
518  North  Austin  Blvd. 

383-6200,  Ext.  6747 

OLNEY 

Richland  Memorial  Hospital 
800  East  Locust  St. 

395-2131 

OTTAWA 

Ryburn  Memorial  Hospital 
701  Clinton  St. 

433-3100 

PARK  RIDGE 

Lutheran  General  Hospital 
1775  Dempster  St. 

692-2210,  Ext.  1220,  1460 

PEKIN 

Pekin  Memorial  Hospital 
14th  & Court 

347-1151,  Ext.  233,  241 

PEORIA 

Methodist  Hospital 

221  Northeast  Glen  Oak  Ave. 

685-6511,  Ext.  250 
Proctor  Community  Hospital 
5409  North  Knoxville  Ave. 

691-4702,  Ext.  791,  792 
St.  Francis  Hospital 

530  Northeast  Glen  Oak  Ave. 

674-2943 

PERU 

Peoples  Hospital 
925  West  Street 

223-3300,  Ext.  55,  40 

PITTSFIELD 
mini  Community  Hospital 
640  West  Washington  St. 

285-2115,  Ext.  238,  213 

PRINCETON 
Perry  Memorial  Hospital 
530  E.  Park  Ave. 

875-2811,  Ext.  311 

QUINCY 

Blessing  Hospital 
1005  Broadway 

223-5811,  Ext.  211,  212 
St.  Mary’s  Hospital 
1415  Vermont  St. 

223-1200,  Ext.  275 


ROCKFORD 

Rockford  Memorial  Hospital 
2400  North  Rockton  Ave. 

968-6861,  Ext.  441 

St.  Anthony’s  Hospital 
5666  E.  State  St. 

226-2041 

Swedish-American  Hospital 
1316  Charles  St. 

968-6898,  Ext.  602 

ROCK  ISLAND 
St.  Anthony’s  Hospital 
767-30th  St. 

226-2041 

ST.  CHARLES 
Delnor  Hospital 
975  North  Fifth  Ave. 

584-3300,  Ext.  218,  229,  286 

SCOTT  AIR  FORCE  BASE 
USAF  Medical  Center 
256-7595 

SPRINGFIELD 
Memorial  Hospital 
First  and  Miller  Sts. 

528-2041,  Ext.  333 
St.  John’s  Hospital 
701  E.  Mason  St. 

544-6451,  Ext.  375 

STREATOR 
St.  Mary’s  Hospital 
1 1 1 E.  Spring  St. 

672-3189,  Ext.  221 

URBANA 
Carle  Hospital 
611  W.  Park  St. 

337-3313 
Mercy  Hospital 

1400  West  Park  Ave. 

337- 2131 

WAUKEGAN 

St.  Therese  Hospital 
West  Waukegan  St. 

688-6470-71 

Victory  Memorial  Hospital 
1324  North  Sheridan  Road 

688-4181 

WOODSTOCK 

Memorial  Hospital  for  McHenry  County 
527  West  South  St. 

338- 2500,  Ext.  32 


ZION 

Zion-Benton  Hospital, 
2500  Emmaus  Ave. 
872-4561,  Ext.  240 


for  October,  1970 


433 


PACKAGED  DISASTER  HOSPITALS  IN  ILLINOIS 


ILLINOIS  DEPARTMENT  OF  PUBLIC  HEALTH 
Emergency  Health  Section 
535  W.  Jefferson 
Springfield,  Illinois 
Phone:  (217)  525-  4659  or  -4812 


ALTON 

St.  Joseph’s  Hospital 
ANNA 

Anna  State  Hospital 
AURORA 

Copley  Memorial  Hospital 

BELVIDERE 

St.  Joseph’s  Hospital 

BENTON 
Franklin  Hospital 

CAIRO 

St.  Mary’s  Hospital 

CANTON 

Graham  Hospital 

CARLINVILLE 

Carlinville  Hospital 

CENTRALIA 

St.  Mary’s  Hospital 

CHARLESTON 

Community  Memorial  Hospital 
CHESTER 

Chester  Memorial  Hospital 

CHICAGO  HEIGHTS 
St.  James  Hospital 

DANVILLE 

Lakeview  Memorial 
St.  Elizabeth’s  Hospital 

DECATUR 

Decatur  Memorial  Hospital 
DEKALB 

DeKalb  Public  Hospital 

DES  PLAINES 
Forest  Hospital 
Holy  Family  Hospital 

DIXON 

Dixon  State  School 
DU  QUOIN 

Marshall  Browning  Hospital 
ELGIN 

Elgin  State  Hospital 
Sherman  Hospital 


ELMHURST 

DuPage  Memorial  Hospital 

EVANSTON 

St.  Francis  Hospital 

FREEPORT 
Freeport  Memorial 

GALESBURG 
Cottage  Hospital 
Galesburg  State  Hospital 

HARRISBURG 

Harrisburg  Hospital 

HIGHLAND  PARK 

Highland  Park  Hospital 

HILLSBORO 

Hillsboro  Hospital 

JACKSONVILLE 

Jacksonville  State  Hospital 

JERSEYVILLE 

Jersey  Community  Hospital 

JOLIET 

Silver  Cross  Hospital 

KANKAKEE 

Kankakee  State  Hospital 
St.  Mary’s 

LAKE  FOREST 

Lake  Forest  Hospital 

LINCOLN 

Abraham  Lincoln  Memorial  Hospital 
Lincoln  State  School 

LITCHFIELD 

St.  Francis  Hospital 

MANTENO 

Manteno  State  Hospital 
MATTOON 

Memorial  Hospital  of  Coles  County 

McHENRY 

McHenry  Hospital 

METROPOLIS 

Massac  Memorial  Hospital 

MONMOUTH 

Monmouth  Hospital 

MURPHYSBORO 

St.  Joseph  Memorial  Hospital 


434 


Illinois  Medical  Journal 


MORRIS 

Morris  Hospital 

NORMAL 

Brokaw  Hospital 

OAK  FOREST 

Oak  Forest  Hospital 

OAK  LAWN 

Christ  Community  Hospital 
OLNEY 

Richland  Memorial  Hospital 

OTTAWA 

Ryburn  Hospital 

PARIS 

Paris  Hospital 
PEKIN 

Pekin  Memorial  Hospital 

PEORIA 

St.  Francis  Hospital 

PONTIAC 
St.  James  Hospital 

PRINCETON 

Perry  Memorial  Hospital 

QUINCY 

St.  Mary’s  Hospital 


RED  BUD 

St.  Clement’s  Hospital 
ROCKFORD 

Swedish-American  Hospital 
RUSHVILLE 

Sara  D.  Cubertson  Hospital 

ST.  CHARLES 
Delnor  Hospital 

SANDWICH 

Sandwich  Community  Hospital 
STERLING 

Community  General  Hospital 

URBANA 

Carle  Hospital 

WAUKEGAN 
St.  Therese 

WATSEKA 

Iroquois  Hospital 

WINFIELD 

Central  DuPage  Hospital 

WOOD  RIVER 

Wood  River  Hospital 

ZION 

Zion-Benton  Hospital 


IDPA  TO  USE  NEW  CPT  IN  1971 

The  Illinois  Department  of  Public  Aid  is  currently  re-programming 
its  computer  to  process  payments  to  physicians  according  to  procedural 
codes  listed  in  the  new  AMA  Current  Procedural  Terminology,  second 
edition  (the  "blue"  book).  The  revision  is  expected  to  be  completed  and 
ready  for  use  early  in  1971. 

The  new  coding  procedure  uses  a five-digit  code  (instead  of  the 
four-digit  one  now  in  use)  which  provides  for  greater  accuracy  in  the 
listing  of  services  provided.  Other  improvements  include  increased 
specificity,  the  addition  of  many  new  procedures  and  listings  by  sys- 
tem or  region. 

This  new  edition  of  the  CPT  is  now  available  from  the  American 
Medical  Association,  Circulation  and  Records  Department,  525  North 
Dearborn  St.,  Chicago,  Illinois  60610.  Price  $2.00.  Each  physician  is 
urged  to  order  his  copy  now  so  as  to  become  familiar  with  the  changes 
and  additions;  however,  they  are  asked  NOT  to  use  this  coding  at  the 
present  time.  Additional  information  concerning  the  effective  date  for 
its  use  will  be  published  in  the  Illinois  Medical  Journal,  and  the  Public 
Aid  Department  will  notify  each  participating  physician  by  letter. 


for  October,  1970 


435 


Medical  Legal  Information 

(Prepared  by  ISMS  Legal  Counsel,  Frank  M.  Pfeifer) 

LEGAL  SERVICES  OF  ISMS 


The  Illinois  State  Medical  Society  retains  a 
General  counsel  and  occasionally  uses  the  services 
of  special  counsel  in  implementing  its  various  pro- 
grams. Legal  advice  is  given  to  the  state  society 
and  its  components  as  organizations,  but  is  not 
available  to  individual  members. 

It  is  intended  that  this  article  give  general  in- 
formation only;  for  any  specific  problem  consul- 
tation should  be  had  with  the  physician’s  in- 
dividual attorney. 

The  legal  department  of  the  Society  can  answer 

HOW  TO  SET  YOUR 

It  is  suggested  that  the  physician,  during  his 
lifetime,  compile  in  one  place  needed  informa- 
tion about  the  location  of  important  records  and 
papers.  The  Illinois  State  Medical  Society  urges 
that  a will  be  prepared  by  a competent  attorney 
and  said  will  be  re-evaluated  by  an  attorney  when- 
ever there  is  a material  change  in  any  circumstan- 
ces or  in  state  law. 

The  physician  should,  of  course,  leave  informa- 
tion about  insurance,  real  estate,  and  bank  ac- 
counts just  as  everyone  else  does,  but  he  has 
additional  responsibilities  peculiar  to  his  profes- 
sion. He  should  leave  instructions  for: 

1.  Temporary  coverage  of  his  practice.  Some 
arrangement  with  a colleague  should  be  made  im- 
mediately for  hospitalized  patients,  and  others 
should  be  notified  of  the  doctor’s  death. 

2.  Patient  records,  which  should  be  carefully 

LEGAL  LIABILITY 

The  legal  liability  of  physicians  is  a question 
on  which  much  has  been  written.  It  has  also  been 
the  topic  of  discussion  at  many  meetings  of  medi- 
cal and  medical-legal  groups.  However,  because  of 
the  grave  nature  of  the  problem,  the  Illinois  State 
Medical  Society’s  legal  counsel  believes  that  the 
subject  cannot  be  overemphasized. 

Statistics  prove  that  the  number  of  malpractice 
and  general  liability  suits  against  physicians  is  on 
the  increase.  This  does  not  mean  that  physicians 
are  becoming  less  skillful  or  more  careless  in  their 
diagnosis  and  treatment;  it  probably  means  that 
physicians  are  being  affected  by  the  tremendous 
growth  there  has  been  recently  in  all  types  of 
personal  injury  litigation. 

More  people  than  ever  before  are  receiving 
medical  attention  and  more  are  starting  lawsuits 
against  physicians  when  recovery  is  less  than 
complete. 

Lial>ility  Insurance 

For  this  reason,  it  is  essential  that  every 
physician  carry  liability  insurance  to  protect 
him  against  all  possible  claims.  The  physician 


specific  questions  propounded  by  officers  of  county 
medical  societies  in  Illinois,  which  are  part  of  and 
make  up  the  state  society,  if  the  questions  are  of 
interest  to  the  membership  as  a whole. 

Although  the  Society  and  its  counsel  cannot 
provide  personal  advice  to  ISMS  members,  it  is  to 
every  physician’s  advantage  to  acquaint  himself 
with  as  much  general  medical-legal  knowledge 
as  possible.  The  following  section,  therefore,  is 
devoted  to  this  kind  of  information. 

AFFAIRS  IN  ORDER 

preserved  for  a minimum  of  10  years  and  for  25 
years,  if  possible.  Contents  of  the  records  should 
be  turned  over  to  another  physician  upon  written 
request. 

3.  Return  of  unused  narcotics  to  the  Treasury 
Department,  the  narcotics  tax  stamp  and  order 
book  to  the  Internal  Revenue  Service,  and  reten- 
tion of  the  narcotics  ledger  for  two  years. 

4.  Disposal  of  his  practice.  If  it  is  to  be  sold, 
rapid  action  is  advised  as  value  is  lost  quickly. 
Equipment  is  best  disposed  of  with  the  sale  of  the 
practice. 

5.  Benefits  that  may  be  due  survivors  from  un- 
used insurance  premiums.  Blue  Cross-Blue  Shield, 
Veterans  Administration,  or  Social  Security. 

As  soon  as  practical  after  death,  the  attorney 
who  will  handle  the  estate  should  be  contacted 
and  his  advice  followed  thereafter. 

OF  PHYSICIANS 

should  be  aware,  however,  that  there  are  some 
inadequate  policies  on  the  market  today  and  an 
attorney  should  be  consulted  before  contracting 
for  insurance  that  may  not  cover  the  doctor’s  par- 
ticular circumstance.  Additional  coverage  insofar 
as  limits  are  concerned  is  relatively  inexpensive 
and  should  be  carried  in  sufficient  amount  to 
cover  all  possibilities. 

Prior  to  the  1967  Session  of  the  General  As- 
sembly of  Illinois,  the  greatest  recovery  that 
could  be  had  for  wrongful  death  was  $30,000  but 
this  limitation  has  now  been  removed  and  there 
is  no  limit  in  the  amount  which  may  be  recovered 
in  the  case  of  wrongful  death.  This  means  that 
in  malpractice  cases  resulting  in  death,  the  ver- 
dict could  be  extremely  high.  It  is  therefore  recom- 
mended that  all  physicians  take  a look  at  their 
malpractice  insurance  policies  to  determine  that 
they  are  properly  covered  and  in  adequate  limits. 
The  cost  of  this  insurance  does  not  materially 
increase  with  the  increase  in  limits  and  therefore 
extremely  high  limits  are  suggested. 

A physician  today  is  a “sitting  duck”  for  a 
lawsuit  even  though  he  may  in  no  way  be  guilty 


436 


Illinois  Medical  Journal 


of  negligence.  And  lawsuits  to  defend,  no  matter 
how  meritorious,  require  the  expenditure  of  time 
and  money. 

Legal  implications  in  this  field  are  wide,  but 
basically  the  physician  is  liable  for  his  own 
negligent  acts  and  the  negligent  acts  of  all  his 
employees.  In  the  case  of  a partnership,  he  is 
also  liable  for  the  negligent  acts  of  his  partners. 

While  the  right  kind  of  insurance  in  sufficient 
amount  will  protect  the  physician  financially,  steps 
should  be  taken  by  all  doctors  to  help  minimize 
the  filing  of  lawsuits  of  this  kind  and  to  work  for 
reduction  in  the  number  of  guilty  verdicts  being 
obtained. 

The  American  Medical  Association  has  pre- 
pared, and  has  available  for  distribution,  several 
interesting  pamphlets  and  papers  on  this  subject. 
The  pamphlet  entitled,  “Professional  Liability  and 
the  Physician,”  reprinted  from  the  February,  1963 
issue  of  the  Journal  of  the  American  Medical 
Association,  contains  this  statement: 

Physician’s  Responsibility 

“In  the  final  analysis,  the  physician  himself 
must  share  the  responsibility  for  the  continuing 
existence  of  the  unpleasant  professional  liability 
situation.  Many  physicians  have  been  satisfied  to 
pay  their  professional  liability  insurance  premiums 
and  thereafter  to  sit  back  complacently,  doing 
nothing  until  they  become  a target.  Every  phy- 
sician must  be  brought  to  realize  that  this  money 
payment  is  only  part  of  his  insurance  program; 
a much  more  important  part  is  his  contribution 
of  time,  study,  and  attention  to  put  into  effect 
all  possible  measures  to  safeguard  the  patient, 
himself,  and  his  colleagues.  Professional  liability 
is  in  no  sense  merely  an  insurance  problem.  It 
is  a medical  problem  and  must  be  combatted  by 
members  of  the  medical  profession.” 

The  AMA  phamphlet  goes  on  to  say  that  “pre- 
vention is  the  best  possible  defense  against  claims 
and  suits”  and  lists  these  20  prevention  “com- 
mandments”: 

1.  The  physician  must  care  for  every  patient 
with  scrupulous  attention  given  to  the  require- 
ments of  good  medical  practice. 

2.  The  physician  must  know  and  exercise  his 
legal  duty  to  the  patient. 

3.  The  physician  must  avoid  destructive  and 
unethical  criticism  of  the  work  of  other  physicians. 

4.  The  physician  must  keep  records  which 
clearly  show  what  was  done  and  when  it  was 
done,  which  clearly  indicate  that  nothing  was  ne- 
glected, and  which  demonstrate  that  the  care  given 
met  fully  the  standards  demanded  by  the  law. 
If  any  patient  discontinues  treatment  before  he 
should,  or  fails  to  follow  instructions,  the  records 
should  show  it;  a good  method  is  to  preserve  a 
carbon  copy  of  the  physician’s  letter  advising  the 
patient  against  the  unwise  course. 

5.  A physician  must  avoid  making  any  state- 


ment which  constitutes,  or  might  be  construed 
as  constituting  an  admission  of  fault  on  his  part. 
He  should  instruct  employees  to  make  no  such 
statements. 

6.  The  physician  must  exercise  tact  as  well  as 
professional  ability  in  handling  his  patients,  and 
should  insist  on  a professional  consultation  if  the 
patient  is  not  doing  well,  if  the  patient  is  unhappy 
and  complaining,  or  if  the  family’s  attitude  in- 
dicates dissatisfaction. 

7.  The  physician  must  refrain  from  over-opti- 
mistic prognoses. 

8.  The  physician  must  advise  his  patients  of 
any  intended  absences  from  practice  and  recom- 
mend, or  make  available,  a qualified  substitute. 
The  patient  must  not  be  abandoned. 

9.  The  physician  must  unfailingly  secure  an 
"informed”  consent  (preferably  in  writing)  for 
medical  and  surgical  procedures  and  for  autopsy. 

10.  The  physician  must  carefully  select  and 
supervise  assistants  and  employees  and  take  great 
care  in  delegating  duties  to  them. 

11.  The  physician  should  limit  his  practice  to 
those  fields  which  are  well  within  his  qualifica- 
tions. 

12.  The  physician  must  frequently  check  the 
condition  of  his  equipment  and  make  use  of 
every  available  safety  installation. 

13.  The  physician  should  make  every  effort 
to  reach  an  understanding  with  his  patient  in  the 
matter  of  fees,  preferably  in  advance  of  treat- 
ment. 

14.  The  physician  must  realize  that  it  is  dan- 
gerous to  diagnose  or  prescribe  by  telephone. 

15.  The  physician  should  not  sterilize  a patient 
solely  for  the  patient’s  convenience  except  after  a 
reasonably  complete  explanation  of  the  procedure 
and  its  risks  and  possible  complications  and  after 
obtaining  a signed  consent  from  the  patient  and 
from  the  patient’s  spouse  if  the  patient  is  married. 
Such  sterilization  is  a crime  in  Connecticut,  Kan- 
sas, and  Utah  and  should  not  be  performed  in 
those  states.  Eugenic  sterihzation  should  be  per- 
formed only  in  conformity  with  the  law  of  the 
state,  if  any.  Sterilization  for  therapeutic  purposes 
may  lawfully  be  performed  with  the  informed 
consent  of  the  patient  and  preferably  with  the  in- 
formed consent  of  the  patient’s  spouse,  if  the 
patient  is  married. 

16.  Except  in  an  actual  emergency  situation 
which  makes  it  impossible  to  avoid  doing  so,  a 
male  physician  should  not  examine  a female 
patient  unless  an  assistant  or  nurse,  or  a member 
of  the  patient’s  family  is  present. 

17.  The  physician  should  exhaust  all  reasonable 
methods  of  securing  diagnosis  before  embarking 
upon  a therapeutic  course. 

18.  The  physician  should  use  conservative  and 
less  dangerous  methods  of  diagnosis  and  treatment 
wherever  possible,  in  preference  to  highly  toxic 
agents  or  dangerous  surgical  procedures. 


for  October,  1970 


437 


19.  The  physician  should  read  the  manufac- 
turer's brochure  accompanying  a toxic  agent  to 
be  used  for  diagnostic  or  therapeutic  purposes, 
and,  in  addition,  should  ascertain  the  customary 
dosage  or  usage  in  his  area. 

20.  The  physician  should  be  aware  of  all  the 
known  toxic  reactions  to  any  drug  he  uses,  to- 
gether with  the  proper  methods  for  treating  such 
reactions. 

The  general  counsel  for  the  Illinois  State  Medi- 
cal Society  has  given  the  following  suggestions 
on  how  to  avoid  and  defeat  malpractice  suits: 

1.  Physicians  should  conduct  their  practice  in 
hospitals  so  that  they  comply  with  and  live  up 
to  the  standards  for  hospital  accreditation  of  the 
American  Hospital  Association,  the  hospital  regu- 
lations adopted  by  the  State  Department  of  Pub- 
lic Health  under  the  Hospital  Licensing  Act  and 
the  by-laws  of  the  hospital  in  which  they  are 
practicing. 

2.  Physicians  should  keep  up  on  modern  medi- 
cine in  the  fields  in  which  they  practice  so  they 
are  conversant  with  and  use  the  latest  proven 
developments. 

3.  Physicians  should  call  in  specialists  when- 
ever the  need  arises. 

4.  Physicians  should  provide  for  automatic  con- 
sultation in  all  serious  cases — it  cannot  be  dis- 
puted that  any  physician  being  called  on  to  de- 
fend his  treatment  in  court  is  in  a much  better 
position  if  he  can  also  bring  forth  as  a witness 
the  physician  who  reviewed  the  case  and  con- 
sulted with  him,  or  the  specialist  in  a given  field 
called  in  by  him. 

5.  Hospital  records  and  those  of  the  physician 
should  be  kept  in  such  manner  and  in  such  de- 
tail as  will  be  meaningful  and  show  that  adequate 
medical  procedures  were  followed.  It  should  be 
remembered  that  frequently  cases  are  not  filed 
until  some  time  after  the  alleged  injury  took  place 
and  sometimes  do  not  come  to  trial  for  several 
years  thereafter. 

6.  All  cases  should  be  treated  in  such  a man- 
ner and  records  kept  as  if  the  case  would  result 
in  a malpractice  suit  and  would  not  come  to 
trial  for  a considerable  period  of  time  after  the 
alleged  injury  had  taken  place. 

7.  Physicians  should  carry  adequate  malprac- 
tice insurance. 

The  Illinois  State  Medical  Society  has  published 
a pamphlet,  “The  Physician’s  Liability  in  Patient 
Care,”  which  is  available  for  distribution  to  any 
physician  who  does  not  have  a copy  and  desires 
one. 

Consent  by  Minors  to  Medical 
Treatment  and  Operations 

The  general  law  in  Illinois  is  that  a minor 
cannot  give  legal  consent  or  waive  any  rights 
which  he  has  under  the  law.  In  the  year  1961, 
the  Illinois  legislature  made  an  exception  to  this 


rule  by  specifically  providing  that  consent  to  the 
performance  of  medical  or  surgical  treatment  by 
a licensed  physician  could  be  executed  by  a mar- 
ried person  who  is  a minor  or  a pregnant  woman 
who  is  a minor  and  shall  not  be  voidable  be- 
cause of  such  minority.  This  act  further  provides 
that  any  parent  who  is  a minor  may  consent  to 
the  performance  upon  his  or  her  child  of  medical 
or  surgical  procedures  by  a licensed  physician 
and  that  the  consent  shall  not  be  voidable  be- 
cause of  such  minority. 

In  the  year  1969,  the  Illinois  legislature  made 
further  exception  to  this  rule  by  providing  that: 

1.  Anyone  18  years  of  age  or  older  may  give 
binding  legal  consent  to  all  medical  and  surgical 
procedures.  (Consent  for  all  operations  or  any 
unusual,  improper  or  dangerous  medical  proced- 
ures should  be  in  writing  regardless  of  age.) 

2.  It  is  no  longer  necessary  for  either  hospital 
or  physician  to  obtain  consent  from  parent  or 
guardian  before  rendering  emergency  treatment 
to  a minor,  if  the  obtaining  of  the  consent  might 
adversely  affect  the  condition  of  the  minor’s 
health. 

3.  Anyone  over  the  age  of  18  years  may  do- 
nate blood  without  the  consent  of  parent  or 
guardian. 

4.  Any  minor  12  years  of  age  or  older  having 
a venereal  disease  may  now  give  consent  to  the 
furnishing  of  medical  care  related  to  the  diag- 
nosis or  treatment  of  such  disease.  All  such  cases 
shall  be  reported  by  the  physician  to  the  State 
Department  of  Public  Health  or  the  local  Board 
of  Health.  Any  physician  providing  diagnosis  or 
treatment  for  a minor  having  a venereal  disease 
may  in  his  discretion  inform  the  parent  or  guard- 
ian of  such  minor  as  to  the  treatment  given  or 
needed. 

5.  Physicians  are  now  specifically  authorized  to 
provide  birth  control  services  including  medical 
and  pharmacological  treatment  and  information 
to  any  minor: 

a)  who  is  married;  or 

b)  who  is  a parent;  or 

c)  who  is  pregnant;  or 

d ) who  has  the  consent  of  his  parent  or  legal 
guardian;  or 

e)  as  to  whom  the  failure  to  provide  such 
services  would  create  a serious  health 
hazard;  or 

f)  who  is  referred  for  such  services  by  a 
physician,  clergyman  or  a planned  par- 
enthood agency. 

Employment  Contract  Between 
Physician  and  Patient 

The  relationship  between  a physician  and  a 
patient  is  one  of  contractual  relationship  and, 
therefore,  a physician  is  under  no  legal  require- 
ment to  accept  anyone  as  a patient  unless  he  so 
desires.  This  rule  is  true  in  the  case  of  an 


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Illinois  Medical  Journal 


emergency  even  though  no  other  physician  is 
available. 

Legally,  a physician  has  the  right  to  refuse 
treatment  in  the  case  of  an  accident  or  other 
emergency  and  could  not  in  any  way  be  held 
liable  for  refusing  to  administer  aid.  (This  is 
strictly  the  legal  answer  and  does  not  involve 
the  moral  or  ethical  question.)  The  rendering  of 
such  services  as  may  be  necessary  in  the  case 
of  an  emergency  does  not  of  itself  give  rise  to 
the  relationship  of  physician  and  patient  and  the 
physician  is  under  no  obligation  to  continue 
treatment  beyond  the  emergency. 

The  physician  in  rendering  emergency  treat- 
ment, however,  must  use  the  same  degree  of  skill 
and  care  as  required  in  other  cases,  taking  into 
consideration  conditions  at  the  scene  of  the  ac- 
cident. 

Continuation  of  Treatment 

A physician  or  surgeon,  on  undertaking  an 
operation  or  treatment,  is  under  the  duty,  in 
the  absence  of  an  agreement  limiting  the  serv- 
ice, of  continuing  his  attendance,  after  the  oper- 
ation or  first  treatments,  as  long  as  the  case 
requires  attention;  and  a surgeon,  in  his  treat- 
ment subsequent  to  an  operation,  is  required  to 
exercise  reasonable  and  ordinary  skill  and  care. 

The  failure  to  give  needed  continued  care 
under  an  obligation  to  do  so  constitutes  negligence 
or  malpractice.  The  obligation  of  continuing  at- 
tention can  be  terminated  only  by  the  cessation 
of  the  necessity  which  gave  rise  to  the  relation- 
ship of  physician  and  patient,  by  mutual  con- 
sent of  the  parties,  by  the  discharge  of  the 
physician  by  the  patient,  or  by  the  physician’s 
withdrawing  from  the  case  after  giving  the  pa- 
tient reasonable  notice  so  as  to  enable  him 
to  secure  other  medical  attendance. 

A physician  has  the  legal  right  to  withdraw 
from  a case  if  the  patient  breaks  the  contract 
by  failure  to  follow  the  medical  advice  or  treat- 
ment and  direction  of  the  physician,  but  the 
relationship  cannot  be  terminated  until  the  phy- 
sician has  advised  the  patient  of  his  withdrawal 
from  the  case  and  has  allowed  the  patient  a 
reasonable  length  of  time  to  procure  another 
doctor. 

Written  Notice 

What  is  reasonable  notice  to  the  patient  de- 
pends upon  the  circumstances  of  each  case. 
Factors  which  must  be  taken  into  consideration 
are  the  condition  of  the  patient,  the  size  of  the 
community,  and  the  availability  or  other  phy- 
sicians. In  order  to  be  completely  safe,  prior  to 
withdrawal  from  the  case,  the  physician  should 
advise  the  patient  in  writing  of  his  intent  to  with- 
draw, his  reasons  therefor,  and  the  fact  that  he 
will  make  available  the  patient’s  case  history  and 
information  regarding  diagnosis  and  treatment  to 
the  new  physician  when  selected  by  the  patient. 


Should  the  patient  return  to  the  original  phy- 
sician stating  that  he  has  been  unable  to  procure 
other  medical  aid,  treatment  should  not  be  re- 
fused until  a replacement  has  been  obtained. 

A physician  has  the  right  to  leave  his  prac- 
tice temporarily  if  he  makes  provisions  for  the 
attendance  of  a competent  physician  during  his 
absence.  This  notice,  which  again  preferably 
should  be  in  writing,  should  be  in  sufficient  time 
so  that  patients  can  obtain  replacements  of  their 
own  choice  if  they  do  not  desire  to  consult  the 
physician  temporarily  handling  the  practice  of  the 
absent  physician. 

GOOD  SAMARITAN  ACT 

The  1965  Legislature  passed  the  so-called 
“Good  Samaritan  Bill”  providing  that  any  phy- 
sician, who  in  good  faith,  provides  emergency 
care  without  a fee  at  the  scene  of  a motor  ve- 
hicle accident  or  in  case  of  nuclear  attack  shall 
not  as  a result  of  his  acts  or  omissions,  except 
in  the  case  of  gross  willful  or  wanton  negligence, 
be  liable  for  damages.  (Paragraph  2a  of  Chapter 
91,  Illinois  Revised  Statutes,  1967.) 

In  1969  this  Act  was  further  amended  to  ex- 
tend the  physician’s  immunity  to  any  type  of 
accident. 

HOSPITAL  PATIENT  RECORDS 

The  1969  session  of  the  General  Assembly 
passed  a new  act  which  provides  that  all  pri- 
vate or  public  hospitals  shall,  upon  the  demand 
of  any  patient,  allow  his  physician  or  attorney 
to  examine  his  hospital  records  and  to  make 
copies  thereof.  The  only  exception  is  in  connec- 
tion with  records  relating  to  psychiatric  care. 
Demands  for  such  records  must  be  in  writing 
and  shall  be  delivered  to  the  administrator  of  the 
hospital. 

HOSPITAL  EMERGENCY  ROOMS 

For  many  years  Illinois  law  has  required  that 
both  public  and  private  hospitals,  where  surgi- 
cal operations  are  performed,  must  provide 
emergency  medical  treatment  or  first  aid  to  any 
person  who  applies  for  same  in  the  case  of  in- 
jury or  acute  medical  condition  where  the  same 
is  liable  to  cause  death  or  severe  injury  or  ser- 
ious illness.  This  act  provides  penalties  for  non- 
compliance. 

In  the  1969  session  of  the  Legislature  this  act 
was  amended  by  Senate  Bill  568  by  allowing  two 
or  more  hospitals  to  combine  for  the  purpose  of 
providing  this  emergency  service  upon  an  area 
wide  or  community  basis  but  with  the  require- 
ment that  the  plan  of  consolidation  be  reduced 
to  writing  and  approved  by  the  Illinois  Depart- 
ment of  Public  Health  prior  to  its  implementa- 
tion. 

INTERNAL  REVENUE  CODE 

It  should  be  evident  to  the  busy  physician  that 


for  October,  1970 


439 


it  is  just  as  unwise  for  him  to  be  his  own  tax  con- 
sultant as  it  is  for  every  man  to  be  his  own 
doctor.  The  physician  is  well  aware  that  in  seek- 
ing to  keep  abreast  of  all  of  the  ramifications  and 
developments  of  modern  medicine,  he  has  a bur- 
den that  is  becoming  increasingly  difficult  to  sus- 
tain and  that  he  has  very  little  time  to  devote  to 
subjects  as  complex  as  taxation,  which  is  right- 
fully the  province  of  his  accountant  and  lawyer. 

Taxation  in  the  United  States  is  complex  and 
many  tax  matters  have  no  particular  application  to 
the  medical  profession  as  such.  However,  the 
doctor  as  a citizen  should  be  aware  that  he  is 
greatly  affected  by  a subject  so  varied  and  so 
complicated  that  the  statutes  themselves  require 
some  1,500  pages  to  be  set  forth.  And  he  should 
know  that  sections  1(a)  through  8023(b)  are 
printed  in  a size  of  type  that  should  be  of  some 
benefit  in  fees  to  practitioners  who  concern  them- 
selves with  the  human  eye.  Surely  the  point  that 
physicians  are  well  advised  to  place  their  prob- 
lems with  accounting  and  legal  advisors  is  fur- 
ther exemplified  by  such  facts  as  the  following: 

Regulations  implementing  the  Internal  Revenue 
Act  require  some  9,700  pages  for  them  to  be 
spelled  out  and  that,  in  order  to  designate  the  dif- 
ferent regulations,  the  government  needs  to  entitle 
the  regulations  as  Regulation  Section  1.0-1  through 
Regulation  Section  301.770-11. 

lust  as  the  patient  would  be  so  much  better 
served  if  he  saw  his  doctor  regularly  before  dif- 
ficulties became  advanced,  so  the  physician’s  inter- 
ests would  be  better  served  if  he  would  seek  ad- 
vice on  income  and  estate  tax  problems  before  the 
fact,  rather  than  after  problems  have  arisen. 

PROCEDURES  AND  REPORTS  IN 
CONTROL  OF  NARCOTIC  DRUGS 

Physicians  are  subject  to  control  by  both  the 
state  of  Illinois  and  the  federal  government  in 
relation  to  narcotic  drugs.  The  numerous  pro- 
visions of  the  federal  regulations  are  set  forth  in 
a fairly  lengthy  pamphlet  entitled,  “Regulations 
No.  5 Relating  to  the  Importation,  Manufacture, 
Production,  Sale,  etc.,  of  Opium,  Coca  Leaves, 
Isonipecaine  or  Opiates,”  which  was  reprinted 
April  1,  1957,  and  is  available  at  a cost  of  45 
cents  through  the  Superintendent  of  Documents, 
U.  S.  Government  Printing  Office,  Washington, 
D.  C.  This  is  published  by  the  Bureau  of  Nar- 
cotics of  the  U.  S.  Treasury  Department. 

The  state  of  Illinois’  “Uniform  Narcotic  Drug 
Act”  has  been  in  effect  since  Jan.  1,  1958.  It  is 
found  in  paragraphs  22-1  through  22-49,  inclusive, 
Chapter  38  of  Illinois  Revised  Statutes,  1967.  The 
Division  of  Narcotic  Control’s  current  rules  and 
regulations  to  implement  the  Act  have  been  in 
effect  since  Apr.  1,  1960.  They  cover  such  matters 
as  prescriptions  and  official  forms  therefor, 
emergencies  excusing  use  of  other  than  official 
prescription  forms,  reporting  or  loss  or  theft  of 


such  prescription  blanks,  records  to  be  kept  by 
the  physician,  dispensing  of  hypodermic  syringes 
and  needles,  prescribing  procedures  in  hospitals, 
and  other  subjects  related  to  narcotic  drugs.  The 
Act  and  the  rules  and  regulations  are  available  at 
no  cost  through  the  Division  of  Narcotic  Control, 
623  E.  Adams  St.,  Springfield. 

Further,  the  state  of  Illinois  has  had  in  effect 
since  Jan.  1,  1960,  a “Uniform  Drug,  Device  and 
Cosmetic  Act.”  Its  rules  and  regulations  control 
such  things  as  the  keeping  of  adequate  rec- 
ords, for  a period  of  two  years,  of  all  purchases 
and  dispositions  of  dangerous  drugs  as  such  drugs 
are  defined  by  the  Act.  A publication  containing 
the  Act  and  the  pursuant  rules  and  regulations 
is  also  available  through  the  Division  of  Nar- 
cotic Control  in  Springfield. 

All  physicians  are  urged  to  have  in  their  posses- 
sion copies  of  both  the  state  and  federal  narcotic 
control  acts  and  the  rules  and  regulations  imple- 
menting them.  As  these  laws  and  regulations  are 
changed  from  time  to  time,  every  effort  should  be 
made  to  have  the  current  rules. 

PROCEDURES  AND  REPORTS  AS  TO 
COMMUNICABLE  DISEASES 
In  order  to  be  conversant  with  the  presently 
governing  rules  and  regulations  as  to  the  control 
of  communicable  diseases  and  the  physician’s 
duties  as  to  reports  and  procedures  in  relation 
to  these  afflictions,  it  is  suggested  that  the  phy- 
sician apply  to  the  Department  of  Public  Health 
of  the  State  of  Illinois  at  Room  500,  State  Office 
Building,  Springfield,  for  the  publication  entitled, 
“Rules  and  Regulations  for  the  Control  of  Com- 
municable Diseases,”  which  was  revised  July  1, 
1965. 

ANATOMICAL  GIFT  ACT 
The  law,  in  the  State  of  Illinois,  allows  an  in- 
dividual to  leave  his  body  or  particular  parts 
thereof,  for  medical  science  by  means  of  his  will 
or  a written  statement  carried  upon  his  person 
or  found  among  his  effects.  The  next  of  kin  may 
also  donate  all  or  any  part  of  the  body  for  medi- 
cal science.  The  Illinois  law,  authorizing  the  above, 
is  set  out  at  Paragraphs  551  through  560  of 
Chapter  3,  Illinois  Revised  Statutes,  1969. 

The  Illinois  State  Medical  Society  has  pre- 
pared forms  which  may  be  used  by  both  the 
donor  himself  or  by  the  next  of  kin.  Copies  of 
these  forms  are  available  at  headquarters  office  in 
Chicago. 

Anatomical  Gift 
By  a Living  Donor 

(1) 

I,  , do  hereby  give 

(2) 

to 

(3) 

for  the  following 


440 


Illinois  Medical  Journal 


(4) 

purpose:  


IN  WITNESS  WHEREOF,  I have  hereunto  set 
(5) 

my  hand  and  seal  this  day  of , 

A.D.  19 . 

(6) 

(SEAL) 

Signed,  sealed,  published  and  declared  by  the 

(1) 

said in  the  presence 

of  us,  who  at  his  (her)  request,  in  his  (her) 
presence  and  in  the  presence  of  each  other  have 
hereunto  subscribed  our  names  as  attesting  wit- 
nesses, believing  him  (her)  to  be  of  sound  and 
disposing  mind  and  memory,  free  from  any  undue 
influence,  and  to  know  the  objects  of  his  (her) 
bounty  and  affection. 

(7) 


(7) 


Instructions 

1.  Insert  name  of  person  making  gift. 

2.  Insert:  “my  whole  body”;  or  list  specific  or- 
gans and  parts  to  be  given. 

3.  Insert  name  and  address  of  a physician;  or 
a hospital,  or  a medical  institution  to  receive 
the  gift. 

4.  Insert:  “any  purpose  authorized  by  law;”  or 
“a  transplantation”  or  “therapy;”  or  “re- 
search;” or  “medical  education.” 

5.  Insert  date  of  the  signing  of  this  card. 

6.  Signature  of  donor. 

7.  Signature  and  address  of  two  necessary  wit- 
nesses. 

Anatomical  Gift  by  Next  of  Kin 

Or  Other  Authorized  Person 

I.  I (we)  are  the  surviving: 

1.  □ Spouse  and  adult  sons  and  daughters 

2.  □ Both  parents  or  surviving  parent 

3.  □ Adult  brothers  and  sisters 

4.  □ Guardian  of  the  person  of  the  de- 

cedent 

5.  □ Person  authorized  or  under  obliga- 

tion to  dispose  of  the  body 

of  , who  died  on  the 

day  of , 19 in  the  County 

of  , State  of  ; 

and 

II.  I (we)  hereby  give: 

□ The  entire  body  of  the  deceased. 

□ Any  specific  organs  or  parts  of  the  body 
of  the  deceased  designated  by  the  donee. 

□ The  following  organs  or  parts  of  the 
body  of  the  deceased: 


TO: 


(Insert  name  and  address  of  a physi- 
cian; a hospital;  or  a medical  institution) 
for  one  of  the  following  purposes: 

□ Any  purpose  authorized  by  law. 

□ A transplantation. 

□ Therapy. 

□ Research. 

□ Medical  education. 

III.  I (we)  hereby  represent  and  certify  that  I 
(we)  are  the  person (s)  authorized  to  execute 
this  authorization  in  accordance  with  the  or- 
der of  priority  specified  in  the  Uniform  Ana- 
tomical Gift  Act  as  listed  in  #l  above. 


Name  Relationship  to  deceased  City  & State 


Instructions 

This  form  must  be  signed  by  the  survivor  or 
survivors  in  the  order  of  priority.  Nos.  1 through 
5,  with  all  persons  in  any  category  being  required 
to  sign.  (EXAMPLE:  Form  to  be  signed  by  liv- 
ing spouse  and  all  living  adult  sons  and  daugh- 
ters; but  if  no  survivors  in  this  category,  then  go 
on  to  No.  2 under  which  surviving  parents  or 
parent  must  sign  but  if  no  one  in  this  category, 
go  to  No.  3,  where  all  surviving  brothers  and  sis- 
ters must  sign;  and  in  the  same  manner  through 
Categories  4 and  5 if  necessary.) 

If  additional  signature  lines  are  needed,  they 
may  be  added  at  the  bottom  of  the  form. 

AUTOPSY 

In  Illinois,  the  heirs  and  next  of  kin  can  bring 
an  action  for  mutilation  of  the  body  in  those  cases 
where  an  autopsy  is  performed  without  authority 
or  permission.  In  order  to  avoid  the  possibility  of 
liability,  autopsies  should  only  be  performed,  in 
Illinois,  when  ordered  by  the  coroner  or  upon 
written  consent  given  by  the  next  of  kin.  The  coro- 
ner may  order  an  autopsy  directly  against  the 
wishes  of  the  next  of  kin. 

MEDICAL  CORPORATIONS 

In  1963  the  Illinois  Legislature  for  the  first  time 
authorized  the  formation  of  medical  corpora- 
tions (Paragraph  631  through  647  Chapter  32 
Illinois  Revised  Statutes,  1969).  Under  this  act 
one  or  more  physicians  licensed  to  practice  medi- 
cine may  organize  as  an  Illinois  business  cor- 
poration. All  officers,  directors  and  shareholders 
of  the  corporation  must  be  licensed  under  the 
Medical  Practice  Act. 

After  the  passage  of  this  Act,  Internal  Revenue 
took  the  position  that  physicians  were  not  en- 
titled to  any  tax  benefits  thereunder.  In  those 
cases  appealed,  the  courts  ruled  that  such  benefits 
should  be  allowed. 

In  the  summer  of  1969  Internal  Revenue  re- 


fer October,  1970 


441 


treated  from  this  position  and  now  is  holding 
that  medical  corporations  authorized  under  state 
law  are  valid  and  that  the  tax  benefits  accrue 
to  the  members. 

The  question  as  to  whether  or  not  a medical 
corporation  is  advisable  depends  upon  each  in- 


dividual situation  but  in  most  instances,  tax  dol- 
lars probably  can  be  saved  by  the  formation  of 
such  a corporation.  It  is  suggested  that  physicians, 
whether  practicing  individually  or  in  a group,  con- 
sult their  accountants  and  attorneys  to  determine 
if  such  incorporation  would  be  profitable. 


STATUTE  OF  LIMITATIONS  IN  MALPRACTICE 


The  Supreme  Court  of  Illinois  recently  handed 
down  a decision  in  the  case  of  Lipsey  vi.  Michael 
Reese  Hospital  am!  Dr.  Gerald  Menaker,  (1970) 
in  which  the  Statute  of  Limitations  in  malprac- 
tice cases  was  extended  and,  in  some  instances, 
nullified.  The  law  in  Illinois,  until  this  decision, 
was  that  an  action  of  malpractice  had  to  be  com- 
menced within  two  years  after  the  alleged  negli- 
gent act  took  place  and  if  the  lawsuit  was  not 
filed  within  this  time,  it  was  barred. 

Both  the  physician  and  the  hospital  moved  to 
strike  the  complaint  as  being  barred  by  the  two 
year  Statute  of  Limitation,  but  the  Supreme 
Court,  in  reversing  all  prior  Illinois  law  on  this 
subject,  held  that  it  would  be  unrealistic  and  un- 
fair to  bar  the  cause  of  action  of  the  injured 
party  before  the  negligence  had  been  discovered. 
The  Court  then  specifically  held  that  the  lawsuit 
could  be  filed  any  time  within  two  years  after 
the  act  of  negligence  became  known.  This  so- 
called  “discovery  rule”  has  been  upheld  in  other 
jurisdictions  but  this  was  the  first  time  that  it  has 
been  applied  in  malpractice  cases  in  Illinois. 

In  all  cases  before  the  Illinois  Supreme  Court, 


either  side  may  ask  for  a rehearing  after  a case 
has  been  decided. 

If  the  decision  is  not  changed  on  rehearing  it 
will  mean  that  there  is  no  longer  any  limitation  in- 
sofar as  malpractice  is  concerned,  as  lawsuits  may 
be  brought  at  any  time  within  two  years  after  the 
alleged  act  of  negligence  has  been  discovered  by 
the  patient.  The  specific  holding  of  the  Illinois 
Supreme  Court  is  that,  in  a medical  malpractice 
case,  the  cause  of  action  accrues  at  the  time  of 
the  discovery  of  the  negligence  and  not  at  the  time 
of  its  occurrence. 

In  1965,  the  Illinois  Legislature  added  a new 
section  to  the  Limitations  Act,  which  provided 
that  if  in  the  course  of  any  medical  or  surgical 
treatment  or  operation,  any  foreign  substance  was 
permitted  to  remain  within  the  body  which  caused 
harm,  the  Statute  of  Limitations  would  not  be- 
gin to  run  until  the  negligence  was  discovered, 
but  the  Act  further  provided  that  no  action  could 
be  commenced  beyond  ten  years  after  the  negli- 
gent act.  While  this  Statute  is  not  an  issue  in  this 
case  the  courts  will,  in  the  future,  probably  adopt 
the  discovery  rule  in  this,  categorically,  and  elimi- 
nate the  ten  year  limitation  provision. 


General  Health  Services  Information 

Health  seiwices  information  not  listed  in  this  Reference 
Issue  can  be  obtained  by  contacting  the  following: 


The  Chicago  Hospital  Council 
840  N.  Lake  Shore  Drive 
Chicago  60611 

Department  of  Public  Health 
,503  State  Ollice  Building 
Springfield  62706 

Department  of  Mental  Health 
401  S.  Spring  Street 
Springfield  62706 

Department  of  Children  & Family  Services 
Room  404,  New  State  Office  Building 
Springfield  62706 

Department  of  Public  .kid 
618  F.  Washington  Street 
Springfield  62706 


Department  of  Registration  & Education 
160  N.  LaSalle  Street 
Chicago  60601 

Department  of  .Mliecl  Medical  Professions  & Services 
American  Medical  Association 
535  N.  Dearborn  Street 
Chicago  60610 

Division  of  Vocational  Rehabilitation 
623  E.  Adams  Street 
Springfield  62706 

Illinois  Hospital  Association 
840  N.  Lake  Shore  Drive 
Chicago  60611 

Illinois  League  for  Nursing 
6355  Broadway 
Chicago  60626 


442 


Illinois  Medical  Journal 


Metropolitan  Chicago  Nursing  Home  Association 
43  E.  Ohio  Street,  Suite  1206 
Chicago  60611 

Directories  are  available  for  the  following: 

Dentists 

American  Dental  Directory.  Available  from  the  American 
Dental  Association,  211  E.  Chicago,  Chicago,  Illinois.  An- 
nual. $25.  Lists  members  and  nonmembers,  military  den- 
tists, dental  schools,  associations  linked  to  ADA,  exam- 
ining boards,  health  agencies,  state  dental  organizations, 
etc.  For  Dentists,  lists  name,  address,  birth  year,  dental 
school,  degree,  specialty,  etc. 

Osteopaths 

Yearbook  and  Directory  of  Osteopathic  Physicians.  Ameri- 
can Osteopathic  Association,  212  East  Ohio  Street,  Chi- 
cago. Annual.  .$25  for  first  copy,  $12.50  each  additional 
copy.  Covers  both  members  and  nonmembers,  colleges, 
associated  osteopathic  hospitals.  For  Osteopaths,  lists  name, 
address,  birth  year,  osteopathic  school,  specialty,  etc. 

Physicians  and  Surgeons 

AMA  Geographic  Register  of  Physicians.  AMA,  525  North 
Dearborn,  Chicago.  Every  2 years.  $90.  Latest  volume 
April,  1970.  Covers  both  memliers  and  nonmembers,  col- 
leges, etc.  For  Medical  Doctors,  lists  name,  address,  birth 
year,  type  of  practice,  specialty,  medical  education,  li- 
cense year,  boards  passed,  society  memberships,  etc. 


Podiatrists 

Desk  Reference.  American  Podiatry  Association,  3301  16th 
Street  NVV.  Washington,  D.C.  Annual.  About  $25.  (Free 
to  advertisers;  write  “Business  office”.)  Includes  alphabetic 
and  geographic  listing  of  podiatrists,  affiliated  organiza- 
tions, accredited  colleges,  therapeutic  indices  and  a cata- 
log of  audiovisual,  informational  and  educational  ma- 
terials. For  Podiatrists,  lists  name,  address,  birth  year,  pe- 
diatric specialty,  etc. 

Drugstores 

Hayes  Drugstore  Directory.  Edward  N.  Hayes,  Publisher, 
206  West  4th  Street,  Santa  Ana,  California.  Annual.  $36 
if  buy  regularly;  ,$40  one  time  basis.  I.ists  retail  drug- 
stores, estimating  volume  and  credit  rating.  A list  of 
wholesale  druggists  is  also  included. 

Internships  and  Residencies 

Directory  of  Approved  Internships  and  Residencies,  AMA, 
525  North  Dearborn,  Chicago.  Published  in  the  Fall  of 
the  year.  Free. 

Nursing  Homes 

U.S.  Guide  to  Nursing  Homes.  Published  by  Grosser  & 
Dunlap,  Inc.,  New  York  City.  Each  of  3 volumes  covers 
a geographic  section  of  U.S.;  $2.95  per  volume.  Name  and 
address  of  home,  number  of  beds,  medical  services  avail- 
able, recreation  and  entertainment.  (Even  a section  on 
how  to  tell  someone  they  are  entering  a tiursing  home 
without  feeling  guilty.  Perhaps  a little  too  consutnerish 
for  some,  but  very  worthwhile  for  the  public  relations 
of  tuirsing  homes.) 


for  October,  1970 


443 


INDEX  TO  REFERENCE  SECTION 


Administration,  Division  of  381 

Aging,  Committee  on  366 

Alcoholism,  Committee  on  366 

Allied  Health  Manpower,  Committee  on  366 

American  Medical  Association 

Delegates  and  Alternates  to  350 

Approved  Schools  394 

Artificial  Kidney  Centers  429 

Benevolence,  Committee  on  367 

Board  of  Trustees  349 

Bylaws  327 

Child  Health,  Committee  on  367 

Certified  Laboratory  Assistants, 

Approved  Schools  of 394 

Clinical  Laboratories,  Licensed  423 

Comb-1  Insurance  Form  384 

Committees 

Committee  to  Study  368 

Trustee  District  ...358 

Illinois  State  Medical  Society  366 

Index  380 

Comprehensive  Health  Planning, 

Task  Force  on  378 

Constitution  and  Bylaws  327 

Committee  on  368 

Index  to  341 

Continuing  Education,  Committee  on  368 

Councils  of  the  Illinois  State  Medical 

Society  361 

County  Medical  Societies,  Officers  of  351 

Cytotechnology,  Approved  Schools  of  394 

Delegates  and  Alternates 

to  the  American  Medical  Association  350 

Disaster  Hospital  Manual  385 

District  Committees,  Trustee  358 

Doctor’s  Responsibility  to  the  Press  389 

Drugs  and  Therapeutics,  Sub-Committee  on  ...369 

Ear,  Nose  & Throat,  Health  Committee  370 

Economics  and  Peer  Review,  Council  on  362 

Editorial  Board,  Subcommittee  376 

Educational  & Scientific  Foundation  383 

Committee  on  379 

Education  and  Manpower, 

Council  on  ...362 


Educational  and  Scientific  Services, 

Division  of  381 

Environmental  and  Community  Health, 

Council  on  363 

Ethical  Relations  Committee  369 

Ethics,  Principles  of  Medical  326 

Executive  Committee  369 

Eye  Health  Committee  310 

Films  384 

Finance  Committee  370 

General  Health  Services  Information  442 

Group  Disability  Program  388 

Group  Major  Medical  Expense  Plan  388 

Health  Care  Financing,  Committee  on  371 

Health  Careers  Council  of  Illinois,  Repr.  to  ..379 
Health  Services  Information,  General  442 

History  of  Founding  and  Expansion 

of  ISMS  323 

Hospital  Relations,  Ad  hoc  Committee  on  ...  371 

Hospitals 

Packaged  Disaster  434 

Private  Mental  422 

with  Special  Type  of  Service  421 

State  Mental  422 

State  Schools  for  Mentally  Retarded  422 

House  of  Delegates,  ISMS  Officials  349 

Ex-Officio  Members  of  349 

Illinois  Association  of  the  Professions, 

Representative  to  379 

Illinois  Department  of  Public  Aid, 

Medical  Advisory  Committee  to  403 

Illinois  Medical  Assistants  Association  393 

Liaison  to  379 

Illinois  Medical  Journal 

Editorial  Board  376 

Publications  Committee  375 

Illinois  Medical  Political  Action 

Committee  (IMPAC)  390 

Illinois  State  Government  401 

Executive  Branch  402 

Legislative  Branch  402 


444 


Illinois  Medical  Journal 


Department  of  Public  Aid  

Administrative  Staff  

Advisory  Committees  

Regional  Offices  

Division  of  Vocational  Rehabilitation  

Board  of  Vocational  Education  and 

Rehabilitation  

Department  of  Children  & Family  Services  .... 

Director’s  Office  

Division  of 

Child  Welfare  

Educational  & Rehabilitational 

Services  

Financial  Management  

Personnel  Administration  

Systems  & Data  Processing  

Department  of  Registration  & Education  

Medical  Examining  Committee  

Medical  Practice  Act  

Other  Examining  Boards  

Department  of  Mental  Health  

Management  Group  

Mental  Retardation  Services,  Division  of  .... 

Non  Statutory  Boards  and  Councils  

Office  of  the  Director  

Special  Programs  

Statutory  Boards  and  Councils  

Zones  and  Institutions  

Department  of  Public  Health  

Bureau  of 

Environmental  Health  

General  Administration  

Personal  and  Community  Health  

County  and  Multiple-County  Health 

Departments  

Health  Planning,  Office  of  

Hospitals 

With  Special  Type  of  Service  

Mental  

Non  Statutory  Boards  

Packaged  Disaster  Hospitals  

Poison  Control  Centers  

Regional  Offices  

Statutory  Boards  and  Commissions  

Urban  Health  Departments  

Regional  Medical  Program,  Regional 


Advisory  Committee  415 

State  Officers  402 

Impartial  Medical  Testimony 386 

Committee  on  371 

Index  to  Committees 380 

Index  to  Constitution  and  Bylaws  341 

Index  to  ISMS  Policy  Manual  348 

Inhalation  Therapy,  Approved  Schools  of  ....394 

Insurance,  Committee  on  371 

Insurance  Form,  Comb-1  384 

Insurance  Programs  387 

Laboratory  Services,  Committee  on  372 

Legislation  and  Public  Affairs,  Council  on  ....364 


Legislation  and  Public  Affairs,  Division  of  ....382 


Licensure,  Committee  on  372 

Map  of  Trustee  Districts  357 

Maternal  Welfare,  Committee  on  372 

Medical  Assistants  Association,  Liaison  to  ....379 

Medical  Benevolence,  Committee  on  367 

Medical  Career  Recruitment  Programs  385 

Medical  Ethics,  Principles  of  326 

Medical  Examining  Committee  406 

Medical  Legal  Council  364 

Medical  Legal  Information  436 

Affairs  In  Order,  How  To  Set  Your  436 

Anatomical  Gift  Act  440 

Autopsy  441 

Communicable  Diseases,  Procedures  and 

Reports  as  to  440 

Good  Samaritan  Act  439 

Hospital  Emergency  Rooms  439 

Hospital  Patient  Records  439 

Internal  Revenue  Code  439 

Liability  of  Physicians,  Legal  436 

Medical  Corporations  441 

Narcotic  Drugs,  Procedures  and  Reports 

in  Control  of  440 

Statute  of  Limitations  in  Malpractice  442 

Medical  Practice  Act  406 

Medical  Record  Librarians,  Approved 

School  of  394 

Medical  Schools  in  the  State  of  Illinois  394 

Medical  Technology,  Approved  Schools  of  ....395 

Medicine  & Religion,  Committee  on  373 

Mental  Health,  Illinois  Department  of  412 

Mental  Health  and  Addiction,  Council  on  ....364 
Midwest  Regional  Library  Ass’n 379 


.403 

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,404 

.404 

.405 

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.405 

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.406 

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.412 

.413 

.414 

.412 

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.413 

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.415 

.415 

.415 

.416 

.415 

.421 

.422 

.419 

.434 

.430 

.416 

.417 

.417 


for  October,  1970 


445 


Modern  Management  of  Multiple  Births,  Film  384 


Narcotics,  Committee  on  373 

Nursing 

Approved  Schools  of  396 

Committee  on  374 

Nutrition,  Committee  on  374 

Occupational  Therapy,  Approved  Course  in  ....394 
Officers 

of  County  Medical  Societies  351 

Illinois  State  Medical  Society  349 

and  Places  of  Meeting  Since 

Organization  of  the  Society  324 

State  of  Illinois  402 

Organization  Chart,  ISMS,  360 

Osteopathic  Problems,  Committee  to  Study  ....374 

Packaged  Disaster  Hospitals  434 

Past  Presidents 349 

Physical  Therapy,  Approved  School  of 394 

Physician  Shortage  and  Services  to  Medically 

Deprived  Areas,  Task  Force  on  378 

Physicians’  Placement  and  Student  Loan 

Fund  Program  385 

Poison  Control  Centers  430 

Policy  Committee  374 

Policy  Manual,  ISMS  342 

Index 348 

Pre-Retirement  TV  and  Film  Services  390 

Principles  of  Medical  Ethics  326 

Professional  Liability  Program  388 

Public  Affairs,  Committee  on  375 

Public  Health,  Illinois  Department  of  415 

Public  Relations  and  Membership  Services, 

Council  on  365 

Public  Relations  and  Economics,  Division  of  ..383 

Public  Safety,  Committee  on 375 

Publications 

Committee  on  375 

Division  of  382 

Pulse  384 

Radiation,  Ad  hoc  Committee  on  376 

Radio-Television 

Public  Service  Materials 389 

Regional  Medical  Program 

Regional  Advisory  Committee 415 

Registration  and  Education,  Illinois 

Department  of 406 


Rehabilitation  Services,  Conimittee  oh  376 

Renal  Dialysis  Centers  & Units  428  & 429 

Retirement  Investment  Program  387 

Schools,  Approved 

Certified  Laboratory  Assistants  394 

Cytotechnology  394 

Inhalation  Therapy  394 

Medical  394 

Medical  Record  Librarians  394 

Medical  Technology  395 

Nursing 

Associate  Degree  Programs  396 

Baccalaureate  Degree  Programs  397 

Diploma  Programs  398 

Practical  399 

Occupational  Therapy  394 

Physical  Therapy 394 

X-Ray  Technology  395 

Scientific  Assembly,  Committee  on  376 

Services,  ISMS  381 

Social  and  Medical  Services,  Council  on  365 

Speakers  Bureau, 

Scientific  385 

Special  Publications  384 

Stroke — Early  Restorative  Measures 

in  Your  Hospital,  Film  384 

Student  AMA,  Adv.  Committee  to  377 

Student  Loan  Fund  Program  386 

Student  Loan  Fund,  Committee  on  377 

Swanberg  Foundation  379 

Task  Forces  378 

Tax-Qualified  Retirement  Program 388 

Time  of  Your  Life,  Film  384 

Irustee  District  Committees  358 

Trustees,  Board  of  349 

Vocational  Rehabilitation,  Division  of  404 

Vocational  Rehabilitation,  Adv.  Comm. 

to  the  Div.  of  ; 377 

Woman's  Auxiliary 

Ad  Hoc  Committees  393 

Advisory  Committee  to  the  378 

Chairmen  of  Committees  392 

Directors  392 

District  Councilors  392 

Officers  and  Board  391 

X-Ray  Technology,  Approved  Schools  of 395 


446 


Illitiois  Medical  Journal 


Drastic  Changes  Ahead  for  Your  Practice! 

HEALTH  CARE  DELIVERY  IS  SICK 

hear  the  proposed  Rx  at 

ISMS  Leadership  Conference 

9:00  A.M.  — 4:00  P.M. 

Sunday  — November  15,  1970 
Continental  Plaza  Hotel 
909  N.  Michigan  Avenue 
Chicago,  Illinois 

★ GOVERNMENT’S  Rx. 

Health  Maintenance  Organization 

★ MEDICINE’S  Rx. 

Foundations  for  Medical  Care 

★ HEALTH  INSURANCE  INDUSTRY’S  Rx. 

HIC’s  Four-Point  Formula 

★ HOSPITAL’S  Rx. 

Hospital  Based  Group  Practice 

I 1 

I plan  to  attend  the  ISMS  Leadership  Conference  on  ‘‘Health  Care  Delivery  In  the  70’s”  on  I 

November  15,  1970,  at  the  Continental  Plaza  Hotel  in  Chicago.  Enclosed  is  my  check  for 
I $ covering lunch(es)  ($5.50  per  person).  j 

I Name  

I Address  | 

City Zip I 

I I 

Mail  to:  Illinois  State  Medical  Society,  360  N.  Michigan  Ave.,  Chicago,  Illinois  60601  > 

I 1 


for  October,  19T0 


447 


Meeting  Memos 


October  17-18 — University  of  Kentucky 

Workshop  on  Skin  Problems 

University  of  Kentucky,  College  of  Medicine,  Lex- 
ington, Kentucky 

October  20-22 — American  College  of 
Emergency  Physicians 

2nd  Annual  Scientific  Assembly 
Sahara  Hotel,  Las  Vegas,  Nevada 

October  23 — Northwestern  University 

Symposium  on  the  Use  of  L-Dopa  in  Parkinsonism 
Chicago  Wesley  Memorial  Hospital,  Chicago 

October  23-24 — University  of  Kentucky 

Workshop  on  Cardiac  Auscultation,  Diagnosis  and 
T herapy 

University  of  Kentucky,  College  of  Medicine,  Lex- 
ington, Kentucky 

October  25-29 — American  College  of 
Chest  Physicians 

2nd  Fall  Scientific  Assembly 

Century  Plaza  Hotel,  Los  Angeles,  California 

October  28-31 — American  College  of 
Surgeons,  Committee  on  Trauma 

lOth  Annual  Course  on  Emergency  Aid  ir  Trans- 
portation 

Chicago  Fire  Academy,  Chicago 

October  29-31 — American  College  of 
Gastroenterology 

Postgraduate  Course 
Statler  Hilton,  New  York 

October  29-November  2 — Association  of 
American  Medical  Colleges 

81st  Annual  Meeting 

Biltmore  Hotel,  Los  Angeles,  California 

October  30-31 — University  of  Florida 

2nd  Annual  Birth  Defects  Symposium 
University  of  Florida,  College  of  Medicine,  Gaines- 
ville, Florida 

November  2-5 — Medical  Association  of 
North  America 

November  Assembly 
Palmer  House,  Chicago 

November  2-11 — Mayo  Clinic 

Clinical  Reviews 

Mayo  Civic  Auditorium,  Rochester,  Minnesota 


November  4 — Forest  Hospital 

“Group  Psychotherapy  with  Drug  Abusers” 

Forest  Hospital,  Des  Plaines,  Illinois 

November  6-8 — Congress  of  County 
Medical  Societies 

1970  Annual  Meeting 

Netherland  Hilton  Hotel,  Cincinnati,  Ohio 

November  9-20 — University  of  Illinois 

Postgraduate  Course  in  Laryngology  Ir  Broncho- 
esophagology 

University  of  Illinois  Hospital,  Chicago 

November  11-12 — Cleveland  Clinic  Edu- 
cational Foundation 

Postgraduate  Course  in  Gastroenterology 
2020  East  93rd  Street,  Cleveland,  Ohio 

November  13 — Kidney  Foundation  of 
Illinois 

1970  Symposium  on  Glomerulonephritis 
University  of  Chicago,  Chicago 

November  16-20 — Chicago  Medical  So- 
ciety 

Postgraduate  Course  in  Obstetrics  if  Gynecology 
Knickerbocker  Hotel,  Chicago 

November  9-13 — Chicago  Medical  So- 
ciety 

Postgraduate  Course  in  Internal  Medicine 
Knickerbocker  Hotel,  Chicago 

November  6 — Institute  for  Sex  Educa- 
tion 

12th  Annual  Teaching  Conference  on  Sex  Education 
Sheraton-Chicago  Hotel,  Chicago 

Nov.  6 — Chicago  Surgical  Society 

Scientific  Program 

University  Club  of  Chicago,  Chicago 

Illinois  Department  of  Mental  Health — 

Intensive  Medical  Review  Courses  began  on  August 
8 and  will  continue  until  December  20,  1970.  Sub- 
jects covered  are  Biochemistry,  Physiology,  Pharm- 
acology, Microbiology  and  Pathology.  Inquiries 
should  be  directed  to  the  Department  of  Mental 
Health,  160  North  LaSalle  Street,  Chicago  60601. 

Illinois  Academy  of  General  Praetice — 

22nd  Annual  Postgraduate  Program,  for  further  in- 
formation contact  Academy  of  General  Practice,  14 
East  Jackson  Blvd.,  Chicago  60604. 


$3  Every  Day  for  Taxes 

Nearly  $3  a day  in  taxes  is  collected  for  every  man,  woman,  and  child 
in  the  United  States.  The  Chamber  of  Commerce  of  the  United  States  estimates 
that  federal,  state,  and  local  taxes  this  year  will  amount  to  $1,050  for  every 
person  in  the  country. 


448 


Illinois  Medical  Journal 


Rx  Product  Index 


Achrocidin  287 

Lederle  Laboratories 

Antrocol  321 

Wm.  Poythress  & Co.,  Inc. 

Aventyl  HCL 302-303 

Eli  Lilly  & Company 

Butazolidin ...300-301 

Geigy  Pharmaceutical  Corp. 

Dicarbosil 466 

Arch  Laboratories 

Dyazide 307 

Smith  Kline  & French  Laboratories 

Dimetapp 3rd  Cover 

A.  H.  Robins  Co.,  Inc. 

Kinesed  290-291 

Stuart  Pharmaceuticals  Div. 

Atlas  Chemical  Industries,  Inc. 

Librium 318-319 

Roche  Laboratories 


Neosporin  Ointment  ..299 

Burroughs  Wellcome  & Co. 

Neo-Synephrine  ..288 

Winthrop  Laboratories 

Noludar  310-311 

Roche  Laboratories 

Orenzyme/AVC  295,  296 

National  Drug  Company 

Pro-Banthine  2nd  Cover 

G.  D.  Seai’le  & Co. 

Silain-Gel  308-309 

A.  H.  Robins  Co.,  Inc. 

Serentil  313-316 

Sandoz  Pharmaceuticals 

Tepanil/Quinamm  453,  454 

National  Drug  Co. 

Triavil  292-294 


Merck  Sharp  & Dohme,  Inc. 


Mucomyst 304-305 

Mead  Johnson  Laboratories 


Valium  

Roche  Laboratories 


.Back  Cover 


MANUSCRIPT  INFORMATION 


Original  articles  will  be  considered  for 
publication  with  the  understanding  that 
they  are  contributed  only  to  the  Illinois 
Medical  Journal.  The  Journal  assumes  no 
responsibility  for  the  opinions  and  claims 
expressed  in  the  articles  contributed. 

Manuscripts  should  be  typed,  double 
spaced,  and  submitted  in  duplicate,  one 
original  and  one  carbon.  An  article  should 
not  exceed  12  to  16  manuscript  pages, 
(including  illustrations)  and  should  be 
briefer  if  possible.  Please  enclose  personal 
glossy  photos  of  author  or  authors.  Snap- 
shots are  not  suitable  for  reproduction. 

References  should  be  numbered  and  con- 
form to  the  following  style  in  the  order 
given:  name  of  author,  title  of  article,  name 
of  periodical  with  volume,  page,  month 
(day  of  month  if  weekly)  and  year.  The 
Journal  does  not  assume  responsibility  for 


the  accuracy  of  references  used  with  articles. 

The  first  page  should  list  the  title,  the 
name  of  the  author  (s),  degrees  and  any  in- 
stitutional or  other  credits  as  well  as  the 
author’s  mailing  address.  The  title  should 
be  as  short  as  possible.  Pages  should  be  num- 
bered consecutively.  Tables  are  to  be  typed, 
numbered  and  accompanied  by  a brief  de- 
scriptive title.  Make  drawings  and  charts  in 
black  ink.  If  photographs  are  submitted, 
seird  black  and  white  glossies.  Number  il- 
lustrations consecutively  and  indicate  their 
jrlace  in  the  text.  Number,  indicate  the  top 
and  place  the  author’s  name  on  the  back 
of  each  illustration. 

Address  manuscripts  to: 

T.  R.  Van  Dellen,  M.D.,  Editor 
Illinois  Medical  Journal 
360  N.  Michigan  Ave. 

Chicago,  111.  60601. 


for  October,  1970 


449 


Editorial  Board 

Frederick  Steigman,  M.D.,  Chicago,  Chairman 
Gastroenterology 
Edward  DuVivier,  M.D.,  Alton 
Pediatrics 

Arthur  DeBoer,  M.D.,  Chicago 
Cardiac  Surgeon 

Donald  L.  Unger,  M.D.,  Des  Plaines 
Allergy 

Joseph  H.  Kiefer,  M.D.,  Chicago 
Urology 

Clarence  J.  Mueller,  M.D.,  Sterling 
General  Surgery 
Robert  E.  lane,  M.D.,  Chicago 
Ob-Gyn 

David  Shoch,  M.D.,  Chicago 
Ophthalmology 

Ernest  Lowenstein,  M.D.,  Mt.  Carmel 
Family  Practice 
Newton  DuPuy,  M.D.,  Quincy 
Ob-Gyn 

Thomas  J.  Collins,  M.D.,  Chicago 
Pathology 

Arkell  M.  Vaughn,  M.D.,  Chicago 
Surgery 

William  E.  Adams,  M.D.,  Chicago 
Surgery 

L.  Martin  Hardy,  M.D.,  Chicago 
Pediatrics 

Edward  Cruzat,  M.D.,  Chicago 
General  Surgery 

Neil  Allen,  M.D.,  Morton  Grove 

Resident  in  Neurology  and  Surgery 
Contributor  in  Surgery 

John  M.  Beal,  Chicago 
Contributor  in  Radiology 

Leon  Love,  M.D.,  Maywood 
Contributor  in  Cardiology 

John  R.  Tobin,  M.D.,  Maywood 
Contributor  in  Medical  Progress 
Harvey  Kravltz,  M.D.,  Skokie 
Editor:  Theodore  R.  VanDellen,  M.D. 


Publications  Committee 

Board  of  Trustees 

Jacob  E.  Relsch,  M.D.,  Springfield,  Chairman 
A.  E.  Livingston,  M.D.,  Bloomington 
Warren  W.  Young,  M.D.,  Chicago 


DRIVERS  ARE  THE  ULTIMATE  CULPRITS 


Interstate  systems  and  higliways  are  dan- 
gerously engineered.  Automobiles  are  un- 
sale  at  any  speed.  Traffic  cops  are  never 
around  to  nail  that  idiot  tvho  passed  you 
at  breakneck  speed.  If  you  have  an  acci- 
dent, it’s  not  your  fault.  Right? 

W rong. 

Statistics  collected  and  published  in  a 
booklet  by  The  Travelers  Insurance  Com- 
panies keep  drivers  on  the  hook.  Their 
compilation  of  accident  facts  makes  it  clear 
that  1969’s  record-breaking  toll  of  56,500 
killed  and  4,700,000  injured  is  attributable 
to  driver  error.  If  you  are  eager  to  find  a 
scapegoat,  don’t  read  it. 

Insurance  companies  have  been  berating 
drivers  for  a long  time.  Their  essential 
motive  is  profit:  if  the  accident  rate  is  cut, 
claims  will  be  cut  and  so  will  the  cost  of 
their  product. 

In  their  booklet.  Travelers  takes  a poke 
at  highway  engineers  and  auto  manufac- 
turers, but  they  conclude  from  all  the  ap- 
j^alling  statistics  that  drivers  are  the  ulti- 
mate culprits. 

Drive  defensively— even  if,  or  particularly 
if,  the  driver  is  young. 

This  advice,  stated  over  the  years,  re- 


mains sensible,  according  to  the  annual 
booklet  of  highway  accitlent  statistics. 

One-fifth  of  the  drivers  in  America  to- 
day are  less  than  25  years  of  age.  But  they 
are  involved  in  one-third  of  all  fatal  auto 
accidents. 

Defensive  driving,  according  to  The 
Travelers  booklet,  is  difficult  because  a driv- 
er is  so  often  unable  to  identify  irrespon- 
sible kids  (or  drinkers  or  seniles)  in  time 
to  avoid  them.  The  driver  must  assume  that 
no  one  else  is  responsible  and  alert. 

As  in  past  years,  excessive  speed  was  the 
chief  cause  of  deaths  and  injuries.  High 
speed,  however,  is  not  necessarily  the  big 
killer.  Driving  too  fast  for  conditions  is 
lethal,  too.  Ten  iTiiles  an  hour  can  be  too 
fast  on  glare  ice  or  in  a ‘peasoup’  fog. 

Actually,  the  annual  survey  shows,  more 
fatal  accidents  occur  in  clear,  dry  weather. 
Poor  driving  conditions  make  the  driver 
more  alert  to  what’s  ahead  or  around  him. 
Only  1.8%  of  last  year’s  automobile  fatali- 
ties occurred  in  fog,  and  only  2.1%  in  snow. 

The  answer  to  the  highway  problem  lies 
in  more  and  better  driver  education,  tighter 
laws  and  law  enforcement. 


450 


Illinois  Medical  Journal 


SGGIO  ECONOMIC 

news 


A service  of  the  Public  Relations  and  Economics  Division 


By  Joseph  J.  Lotharius 


Out-Patient  Program 
Cuts  Cost 


Dilatation  & Curettage  was  found  to  cost  80%  less  when 
performed  on  an  out-j)atient  basis  during  a year-long  pilot 
program  at  Joliet’s  $t.  Josejjh’s  Hospital.  In  addition,  this 
D & C procedure,  which  is  often  accompanied  by  several 
days  hospitalization,  also  frees  badly  needed  hospital  space. 
Dr.  I.eon  Gardner,  medical  director  of  the  463-bed  Joliet 
hospital,  reported  that  patients  also  prefer  the  new  pro- 
gram. W’omen  are  admitted  altout  8 a.m.,  taken  to  surgery, 
then  to  the  recovery  room  and  released  about  noon. 

On  the  basis  of  the  pilot  program’s  success,  the  hospital 
is  expanding  its  dollar-saving  experiment  into  other  pro- 
cedures including:  intraocidar  examination  of  infants  and 
children  under  anesthesia;  salivary  and  tear  duct  probing 
in  infants  and  children;  esophagoscopics  and  bronchoscop- 
ies; cystos  and  retrograde  pyelogi'aphy;  minor  orthopedic 
procedures;  and  e.xcision  of  benign  and  malignant  skin 
lesions. 


Medicaid  Payments 
In  Four  Days 


New  Medicare  Rules 
For  Ambulance 
Services 


A feasibility  study  will  be  conducted  in  Sangamon  county 
to  accelerate  reimbursement  of  Medicaid  payments  to  phy- 
sicians, hospitals,  pharmacists  and  dentists.  The  pilot  pro- 
gram is  schedided  to  begin  next  January  1.  Under  the 
unique  program,  the  provider  of  the  services  would  file 
a voucher  ^vith  a bank  and  be  paid  within  four  days.  The 
bank  woidd  give  the  voucher  information  to  a computer 
that  has  been  programmed  with  all  appropriate  fee  infor- 
mation. If  the  voucher  request  does  not  exceed  the  maxi- 
mum fee  allowed,  it  ^votdd  be  acknowledged  and  the  pro- 
vider credited  with  the  money. 

If  successful,  the  plan  'svill  be  expanded  to  include  a seven 
county  area  and  if  that  proves  successful,  the  program  would 
be  tried  on  a statewide  basis. 

A netv  reporting  form  for  ambulance  services  under 
Medicare  will  eliminate  some  of  the  annoying  letters  sent 
to  ])hysicians  by  Medicare  carriers.  According  to  Continen- 
tal Casualty  Co.,  Part  B Medicare  carrier  for  much  of  the 
state,  the  new  form  should  also  expedite  payments  to  physi- 
cians. It  has  been  supplied  to  all  appropriate  ambulance 
services  in  the  state.  Continental  also  reported  a change  in 


/or  October,  1970 


451 


Blue  Shield!  In  Florida 
Asked  To  Spell  It  Out 


the  guidelines  for  ambulance  service,  issued  by  the  Social 
Security  Administration.  The  new  requirement  calls  for 
two-man  crews  on  every  ambulance.  One  of  the  crew  mem- 
bers must  have  received  training  equivalent  to  the  Stand- 
ard & Advanced  Red  Cross  Life  Saving  course. 

Florida  physicians  have  asked  Blue  Shield  in  their  state 
to  print  in  bold  type  on  every  policy  which  does  not  pay 
usual  and  customary  fees  that  “this  policy  does  not  neces- 
sarily cover  the  physician’s  entire  fee.’’  Delegates  to  the 
Florida  Medical  Association  further  have  instructed  Blue 
Shield  “to  work  toward  changes  in  the  payment  schedule 
to  a percentage  of  usual  and  customary  fees  which  would 
vary  for  each  class  or  type  of  policy  sold  by  Blue  Shield  and 
the  latter  should  clearly  inform  each  purchaser  of  the  policy 
limitations.’’  Would  similar  action  by  ISMS  be  the  solution 
for  like  complaints  voiced  by  Illinois  physicians? 


ILLINOIS 

MEDICAL 

ASSISTANTS 

ASSOCIATION 


REPORT 


Improvement  through  education 

By  Mary  Dunham/Chicago 


The  rapid  growth  and  changes  being 
made  in  medicine  are  responsible  for  many 
proposals  for  change  in  our  medical  school’s 
curricula.  New  courses  are  being  offered  in 
junior  colleges  now,  that  were  not  thought 
of  years  ago.  The  new  courses  offered  in 
medical  assisting  are  for  training  personnel 
who  will  perform  tasks  that  will  free  the 
doctor  and  give  him  more  of  his  valuable 
time. 

Members  of  the  Illinois  Medical  Assist- 
ants Association  who  are  nurses,  medical 
secretaries,  technicians,  medical  librarians 
and  receptionists  are  dedicated  to  improve- 
ment through  education.  This  is  so  that 
we  may  become  more  professional  and  bet- 
ter able  to  serve  our  doctor  employers  and 
their  patients.  During  the  year  our  mem- 
bers are  injected  with  helpful  hints  through 
our  bi-monthly  newsletter.  Our  annual  con- 
vention offers  a three  day  symposium  com- 
prised of  topics  suited  to  the  general  at- 


tendance. Usually  several  doctors  lecture  on 
different  topics  related  to  the  field.  The 
lectures  are  followed  by  open  discussion 
and  a question  and  answer  period.  From 
time  to  time  there  are  panels  of  members 
who  acquaint  us  with  the  responsibilities 
and  the  variety  of  duties  they  perform  in 
their  individual  offices.  A professional  sym- 
posium is  planned  also  for  educational 
purposes. 

We  are  constantly  searching  for  doctors 
and  other  medical  personnel  who  will  lec- 
ture to  us  on  topics  that  will  help  us  elevate 
our  standards  as  medical  assistants. 

If  your  medical  assistant  is  interested  in 
membership  jffease  contact  Mrs.  Norma 
Domanic,  150  Ash  .Street,  New  Lennox,  111. 
60451  or  Mrs.  Viv'an  Kraft,  RR  #2,  Nor- 
mal, Illinois  61761. 

Mary  Dunham 
Chicago  Chapter 


452 


Illinois  Medical  Journal 


Experience  in  Hepatic  Transplantation. 
By  Thomas  E.  Starzl,  M.D.,  W.  B.  Saunders 
Company,  Philadelphia,  1969 

It  is  unlikely  that  readers  of  the  Illinois 
Medical  Journal  will  be  performing  hepatic 
transplantation  in  the  near  future.  Never- 
theless, Illinois  in  general,  and  Chicago  in 
particular,  has  had  a long  interest  in  the 
field  of  transplantation.  In  1912,  Alexis 
Carrel,  then  working  in  Chicago,  accepted 
the  Nobel  Prize,  saying,  “From  the  tech- 
nical point  of  view,  the  problem  of  organ 
transplantation  has  been  solved.”  That  Car- 
rel was  overstating  the  case  regarding  liver 
transplantation  is  clear  from  an  inspection 
of  Professor  Starzl’s  book.  His  systematic 
approach  to  solution  of  technical  prob- 
lems of  hepatic  allografting  is  detailed  in 
this  unusual  volume.  Much  of  the  book 
reads  like  a scientific  mystery  story  in  which 
the  ultimate  solution  will  never  be  revealed. 
As  each  chapter  unfolds,  new  facts  of  anat- 
omy, genetics  and  immunology  are  uncov- 
ered. Further  clues  of  pharmacology,  chem- 
istry and  microbiology  lead  the  reader 
toward  a better  understanding  of  organ 
transplantation.  He  is  left  at  the  end  won- 
dering just  how  the  story  will  turn  out. 

This  is  a marvelous  book.  It  is  particu- 
larly interesting  to  physicians  who  are 
keeping  an  eye  on  transplantation  events. 
There  is  far  more  here  than  mere  hepatic 
transplantation.  There  is  a history  of  clin- 
ical transplantation  over  the  last  five  years, 
early  results  of  kidney  transplantation  us- 
ing Azathioprine  and  Prednisone,  and  the 
story  of  development  of  antilymphocyte 
globulin  and  its  early  use  in  man. 

Five  years  ago,  Tom  Starzl’s  book  en- 
titled, Experience  in  Renal  Transplan- 
tation appeared.  This  presented  the  first 
large  series  of  successful  renal  transplants, 
and  recently  that  book  has  been  referred  to 
as  the  “Transplantation  Bible.”  It  showed 


that  with  drug  treatment  alone,  real  pos- 
sibilities existed  for  successful  renal  trans- 
plantation. The  present  volume  is  a com- 
panion to  that  work.  It  was  prepared  with 
the  help  of  a Northwestern  University  med- 
ical student,  Charles  W.  Putnam,  who  then 
moved  his  research  activities  to  the  Uni- 
versity of  Colorado  School  of  Medicine 
where  he  currently  serves  as  an  intern. 

Illinois,  Chicago  and  Northwestern’s  par- 
ticular stake  in  this  volume  is  well  known 
to  those  who  followed  Tom  Starzl’s  career. 
He  holds  Ph.D.  and  M.D.  degrees  from 
Northwestern  University.  He  performed  his 
early  experimental  liver  transplantations 
in  the  surgical  research  laboratories  on 
East  Chicago  Avenue.  This  book  begins 
there  and  pays  tribute  to  his  early  research 
associates.  It  ends  with  a list  of  25  human 
liver  transplants  performed  at  the  Univer- 
sity of  Colorado  from  March,  1963,  through 
February,  1969.  As  it  details  the  care  of 
these  patients,  this  book  teaches  the  lessons 
of  current  immunosuppression  in  man, 
records  experience  in  managing  infectious 
complications  occurring  in  the  immune  sup- 
pressed individual,  covers  current  theory 
regarding  histocompatibility  typing,  as  well 
as  other  important  subjects  such  as  anes- 
thesia and  intra-operative  care  of  transplant 
patients.  Liver  transplantation  has  far 
reaching  effects  and  as  these  cause  changes 
in  the  coagulation  mechanism,  for  example, 
separate  chapters  are  contributed  by  au- 
thorities in  these  subjects. 

This  is  a classic  volume.  It  is  well  printed 
and  magnificently  illustrated  with  drawings 
by  Jean  McConnell  of  the  Northwestern 
University  Medical  Art  Department.  It  will 
be  a valuable  addition  to  the  growing  shelf 
of  modern  transplantation  texts  which  are 
telling  the  story  of  surgery’s  newest  field  of 
endeavor. 

John  J.  Bergan,  M.D. 


for  October,  1970 


455 


NEW 

PHARMACEUTICAL 

SPECIALTIES 

by  Paul  deHaen 


For  detailed  information  regarding  indica- 
tions, dosage,  contraindications,  and  adverse 
reactions,  refer  to  the  manufacturer’s  package 
insert  or  brodiure. 

Single  Chemicals:  Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products:  Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products:  Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms:  Of  a previously  introduced 
product. 

The  following  new  drugs  have  been  marketed: 

NEW  SINGLE  CHEMICAL 

CLEOCIN  HCl  Antibiotic  H 

Manufacturer:  Upjohn 
Nonproprietary  Name:  Clindamycin 
Indications:  Infections  caused  by  gram-positive 
organisms  which  are  susceptible  to  its  action. 
Contraindications:  Hypersensitivity  to  the  com- 
pound. 

Dosage:  Adults  Mild  to  moderately  severe  infec- 
tions— 150-300  mg./6  hrs.  Severe  infections — 
300-450  mg./6  hrs. 

Children:  Mild  to  moderately  severe  infections 
— 8-16  mg./kg./day,  t.i.d.  or  q.i.d.  Severe  in- 
fections— 16-20  mg./kg./day,  t.i.d.  or  q.i.d. 
Supplied:  Capsules,  75  and  150  mg. 

Sensitivity  disks,  2 meg. 

GEOPEN  Antiinfectives-Penicillin  & ' 
Derivatives  B 

Manufacturer:  Roerig  Div.,  Pfizer 

PYOPEN  Antiinfectives-Penicillin  & 

Derivatives  B 

Manufacturer:  Beecham  Pharmaceuticals 
Nonproprietary  Name:  Carbenicillin  disodium 
Indications:  Infections  due  to  susceptible  Pseu- 
domonas aeruginosa,  Proteus  species  and  cer- 
tain strains  of  E.  coli. 

Contraindications:  Known  penicillin  allergy 
Dosage:  i.m.,  i.v.,  individualized 
Supplied:  Vials,  1 and  5 gm. 

KAFOCIN  Antibacterials-Urinary  R 

Manufacturer:  Lilly 

Nonproprietary  Name:  Cephaloglycin  (as  the  di- 
hydrate) 

Indications:  Acute  and  chronic  infections  of  the 
urinary  tract  due  to  susceptible  strains  of 
E.  coli,  Klebsiella-Aerobacter,  staphylococci, 
certain  of  the  Proteus  species  and  enterococci. 
Contraindications:  Known  allergy  to  cephalo- 
sporin antibiotics 

Dosage:  Usual  adult  dose:  250  mg.  q.i.d.  10  days. 

Severe  infections:  500  mg.  q.i.d. 

Usual  children’s  dose:  25-50  mg./kg. 
Supplied:  Pulvules,  250  mg. 

SECRETIN-BOOTS  Diagnostics-Organ 
Function  R 

Manufacturer:  Boots,  England 


Distributor:  Warren-Teed 

Active  ingredient:  Secretin  (Obtained  fi'om  por- 
cine duodenal  mucosa.) 

Indications:  Diagnosis  of  pancreatic  disorders 
Contraindications:  History  of  atopic  asthma,  al- 
lergy or  positive  skin  test. 

Dosage:  For  dosage  and  administration  see  pack- 
age insert. 

Supplied:  Rubber-capped  vials,  10  cc  sterile 
powder. 

SERENTIL  Ataraxic  R 

Manufacturer:  Sandoz 
Nonproprietary  Name:  Mesoridazine 
Indications:  Schizophrenia,  behavioral  problems 
in  mental  deficiency  and  chronic  brain  S5rn- 
drome,  alcoholism — acute  and  chronic,  and  psy- 
choneurotic manifestations. 

Contraindications:  Severe  central  nervous  system 
depression  or  comatose  states  from  any  cause. 
Hypersensitivity  to  the  drug. 

Dosage:  Dependent  on  conditions  treated. 
Supplied:  Tablets,  10,  25,  50  and  100  mg. 

Ampuls,  each  cc  contains  25  mg.  (as 
the  besylate) 

DUPLICATE  SINGLE  PRODUCT 
DIPHENHYDRAMINE 

HYDROCHLORIDE  Antihistamine  R 

Manufacturer:  Wyeth 

Nonproprietary  Name:  Diphenhydramine  HCl 
Indications:  Symptomatic  relief  of  hay  fever  and 
other  allergic  entities.  Prevention  and  control 
of  blood  transfusion  reactions  of  the  non- 
hemolytic, non-pyrogenic  type.  Prophylactic 
treatment  of  symptoms  of  mild  bronchial  asth- 
ma. Antiemetic  action. 

Contraindications:  Intra-arterial  injection 
Dosage:  Usually  effective  orally.  In  emergencies 
i.m.  or  i.v.  administration  may  be  more  effec- 
tive. Adults:  10-50  mg.  i.v.  or  by  deep  i.m. 
injection  100  mg.  if  required  Maximum  daily 
dosage,  400  mg.  Children:  i.m.  route — 10-30 
mg.  by  deep  i.m.  injection,  i.v.  route — 5 mg./ 
kg./24  hr.  in  three  divided  doses. 

Supplied:  Tubex  unit  dose  in  prefilled  sterile 
cartridge -needle  units,  each  cc  contains  50  mg. 

ESTRAVAL  P.A.*  Estrogens  R 

(*Prolonged  Action) 

Manufacturer:  Tutag 
Nonproprietary  Name:  Estradiol  valerate 
Indications:  Disturbances  of  the  menstural  cycle, 
dysfunctional  uterine  bleeding,  amenorrhea, 
deficiency  syndromes,  postpartum  breast  en- 
gorgement and  advanced  mammary  carcinoma 
in  women  5 or  more  years  post-menopausal. 
Often  induces  regressive  changes  and  exerts 
a nalliative  action  in  carcinoma  of  the  pros- 
tate. 

Contraindications:  History  of  known  or  suspected 
malignancy  of  the  uterus  or  breast. 

Dosage:  i.m.,  individualized. 

Supplied:  Multidose  vials,  10  cc. 

E-IONATE-P.A.*  Estrogen  R 

t*Prolonged  Action) 

Manufacturer:  Tutag 

Nonproprietary  Name:  Estradiol  Cypionate 
Indications:  Symptoms  of  menopause,  natural  or 
induced,  treatment  of  pruritis  vulvae  and  senile 
vaginitis. 

Contraindications:  Pre-cancerous  lesions  of  the 
breast  or  genital  tract  or  a familial  history  of 
these  types  of  carcinoma. 

Dosage:  i.m.  only,  1-5  mg./week  initially.  Main- 


456 


Illinois  Medical  Journal 


tenance  2-5  mg.  every  three  or  four  weeks. 
Supplied:  Vials 

T-IONATE  P.A.*  Androgen  B 

(*Prolonged  Action) 

Manufacturer:  Tutag 

Nonproprietary  Name:  Testosterone  Cypionate 
Indications:  Male:  Replacement  therapy  in  con- 
ditions associated  with  deficiencies  or  absence 
of  endogenous  testicular  hormone. 

Female:  Control  of  post-partum  lactation.  Pal- 
liative effect  in  inoperable  cancer. 

Male  and  Female:  Anabolic  effect  in  conditions 
associated  with  androgen  deficiency. 
Contraindications:  Prostatic  carcinoma,  severe 
hypercalcemia  and  severe  cardiorenal  disease. 
Pregnancy. 

Dosage:  Individualized. 

How  supplied:  Vials,  10  cc 

TESTOSTROVAL  P.A.*  Androgen  R 

(*Prolonged  Action) 

Manufactiu-er:  Tutag 

Nonproprietary  Name:  Testosterone  enanthate 
Indications:  Androgenic  deficiency  states 
Contraindications:  Prostatic  or  breast  cancer  in 
the  male  and  in  elderly  patients  where  over- 
stimulation  is  to  be  avoided. 

Dosage:  i.m.,  individualized 
Supplied:  Multi-dose  vials,  5 cc 

■rRATES  GRANUCAPS  Vasodilator-Coronary  R 
Manufacturer:  Tutag 
Nonproprietary  Name:  Nitroglycerin 
Indications:  Angina  pectoris  associated  -with  or 
resulting  from  coronary  insufficiency,  coro- 
nary artery  disease,  coronary  occlusion  or 
myocardial  infarctions. 

Contraindications:  Idiosyncrasy  to  nitroglycerin, 
early  myocardial  infarction,  glaucoma,  in- 
creased intracranial  pressure  and  severe 
anemia. 

Dosage:  One  capsule  at  12  hour  intervals  (before 
breakfast  and  at  bedtime).  Dose  may  be  in- 
creased to  one  every  8 hrs.,  or  as  directed. 
Supplied:  Capsules,  2.5  mg. 

COMBINATION  PRODUCT 

CAMALOX  G.I.  Prep. -Antacids  o-t-c 

Manufacturer:  Rorer 
Composition:  Balanced  suspension  of 
Magnesium  hydroxide 
Aluminum  hydroxide 
Calcium  carbonate 

Indications:  Treatment  and  management  of  pep- 
tic ulcer,  gastritis,  gastric  hyperacidity,  hiatal 
hernia,  peptic  esophagitis,  heartburn,  indiges- 
tion and  upset  stomach. 

Contraindications:  Severe  debilitation  or  kidney 
failure. 

Dosage:  2-4  tsp.  1/2  to  1 hr.  after  meals  and  at 
bedtime. 

Supplied:  Liquid  suspension,  16  oz.  bottle 

FERROBID  Hematinic/Vitamin 
Combination  o-t-c 

Manufacturer:  Meyer 

Composition:  Ferrous  Fumarate  225  mg. 

(75  mg.  elemental  iron) 

Copper  sulfate  8 mg. 

Ascorbic  Acid  100  mg. 

Indications:  Optimal  iron  absorption  with  mini- 
mal gastric  irritation. 

Contraindications:  None  mentioned 
Dosage:  Usual  daily  dose — one  capsule  twice  a 
day. 

Supplied:  Timed  action  Duracap  Capsules 


FLU-IMUNE  Biological 
Manufacturer:  Lederle 
Composition:  Each  cc  contains 

Ao/Aichi/2/68  (Hong  Kong 
Variant)  400  CCA  units 

B/Mass/3/66  300  CCA  units 

Indications:  Influenza  virus  vaccine-bivalent 
Contraindications:  Hypersensitivity  to  eggs  or 
egg  products. 

Dosage:  Adults:  1.0  cc  s.c.,  followed  by  a second 
dose  of  1.0  cc  s.c.  in  6-8  weeks. 

Children:  3 mos.-5  yrs. — 0. 1-0.2  cc  s.c.,  followed 
by  a second  dose  in  two  weeks.  A third  dose 
of  0.1  -0.2  cc  s.c.  should  be  administered  about 
2 mos.  later. 

Children  6 to  10  yrs.:  0.5  cc  s.c.,  repeated  in 
6-8  weeks. 

Supplied:  Vials,  10  cc 


LAROBEC  Vitamin/Mineral  Comb.  R 

Manufacturer:  Roche 

Composition:  Thiamine  mononitrate  15  mg. 

Riboflavin  15  mg. 

Niacinamide  100  mg. 

Calcium  pantothenate  20  mg. 

Cyanocobalamine  5 meg. 

Folic  acid  0.5  mg. 

Ascorbic  acid  500  mg. 


Indications:  Nutritional  supplementation  for  lev- 
odopa  therapy. 

Contraindications:  None  mentioned 
Dosage:  One  or  two  tablets  daily. 

Supplied:  Tablets 

SWIM-EAR  Ear  Preparations  o-t-c 

Manufacturer:  Savage 

Composition:  Boric  acid  2.75% 

Isopropyl  Alcohol  97.25% 

Indications:  Prevention  of  swimmer’s  ear  (ex- 
ternal otitis). 

Contraindications  None  mentioned 
Dosage:  3-6  drops  in  each  ear  after  swimming  or 
showering 

Supplied:  Plastic  squeeze  bottles  with  otic  tip, 
1 oz. 

T-E  lONATE-P.A.*  Androgen/Estrogen 

Combination  R 

(^Prolonged  Action) 

Manufacturer:  Tutag 
Composition:  Each  cc  contains: 

Testosterone  Cypionate  50  mg. 

Estradiol  Cypionate  2 mg. 

Indications:  Menopausal  symptoms,  male  climac- 
terium and  osteoporosis. 

Contraindications:  High  familial  incidence  of 
cancer  including  neoplasms  or  pre-cancerous 
lesions  in  the  mammary,  genital  or  prostatic 
areas. 

Dosage:  Usual  dose:  1 cc  at  four  week  intervals. 
Supplied:  Vials 

NEW  DOSAGE  FORM 

CHOLEDYL  ELIXIR  Bronchodilator  R 

Manufacturer:  Wamer-Chilcott 
Nonproprietary  Name:  Oxtriphylline 
Indications:  Relief  of  bronchospasms  in  chronic 
obstructive  lung  disease. 

Contraindications:  None  mentioned 
Dosage:  Adult:  2 tsp.  q.i.d. 

Supplied:  Elixir,  each  tsp.  contains  100  mg. 

EFUDEX  Cancer  Chemotherapy  R 

Manufacturer:  Roche 
Nonproprietary  Name:  Fluorouracil 
Indications:  Multiple  actinic  or  solar  keratoses 
Contraindications:  Hypersensitivity  to  any  of  its 
components 

(Continued  on  page  465) 


for  October,  1970 


457 


Missed  Myocardial  Infarction 


Myocardial  infarctions  have  a language 
that  sometimes  is  not  heard  by  medical 
audiences,  according  to  Walter  Schweizer, 
M.D.,  v/ho  terms  the  incidence  of  missed 
myocardial  infarction  "astounding." 

Dr.  Schweizer  made  the  observation  in 
"Missed  Myocardial  Infarction,"  an  article 
in  an  issue  of  diagnostica,  an  international 
medical  journal  produced  by  Ames  Com- 
pany, Division  Miles  Laboratories,  Inc.  diag- 
nostica is  published  in  six  languages  and 
distributed  to  physicians  in  112  countries. 

Dr.  Schweizer  is  Head  of  the  Department 
of  Cardiology  in  the  University  Clinic  of 
Internal  Medicine,  Burgerspital,  and  Profes- 
sor of  Cardiology  in  the  Faculty  of  Medicine 
of  the  University  of  Basel,  Switzerland. 

Twenty  per  cent  of  all  myocardial  in- 
farctions are  not  diagnosed.  Dr.  Schweizer 
said.  Half  of  these  undiagnosed  infarctions 
occur  when  sudden  death  or  death  within 
a few  minutes  is  the  first  and  only  mani- 
festation of  the  myocardial  infarction. 

The  other  half  occur  when  the  language 
of  the  infarction  is  not  heard  or  is  inter- 
preted incorrectly  by  medical  audiences. 
Dr.  Schweizer  listed  several  reasons: 

"When  the  myocardial  infarction  is  pain- 
less (no  chest  pain  or  pain  equivalent  ex- 
perienced) the  infarction  is  'silent'  and  re- 
mains undetected  unless  fortuitously  dis- 
covered during  electrocardiography  per- 
formed for  other  reasons."  There  is  no  firm 
basis  for  suspicion  of  infarction. 

"When  the  infarction  causes  only  limited 
pain;  mild  angina  on  effort  of  mild,  brief 
midchest  pressure.  Symptoms  may  be  so 
slight  that  the  patient  does  not  heed  them 
and  does  not  bother  to  consult  a physi- 
cian." This  infarction  is  not  silent  but  it 
speaks  very  softly. 

"When  the  myocardial  infarction  does 
not  produce  adequately  specific  alterations" 
there  may  be  an  ambiguous  clinical  picture 
even  if  the  patient  consults  a physician  and 


a careful  examination  is  performed.  Here 
the  infarction  is  painful  but  it  lacks  typical 
signals.  It  is  not  silent  but  it  speaks  unin- 
telligibly. 

"When  the  investigation  to  demonstrate 
the  infarction  is  begun  too  late  there  is 
again  an  ambiguous  clinical  picture  be- 
cause the  infarction  is  observed  after  the 
signs  have  subsided.  The  infarction  does 
not  remain  silent:  it  "speaks  loudly  and  un- 
mistakably but  only  at  a time  when  no 
one  is  within  hearing  range." 

Today  it  is  vital  that  myocardial  infarc- 
tion and  the  underlying  coronary  heart 
disease  should  not  be  missed  for  three 
reasons.  Dr.  Schweizer  said: 

1.  "Intensive  and  aggressive  coronary 
care  has  reduced  hospital  mortality  due 
to  myocardial  infarction  by  approximately 
50%"  Faster  transportation  and  efficient 
first  aid  also  figure  here. 

2.  "Anticoagulants  improve  the  chance 
of  survival  after  the  initial  myocardial  in- 
farction." Recent  studies  have  shown  that 
the  two-year  mortality  rate  can  be  cut  ap- 
proximately in  half. 

3.  "Sudden  death  occurs  in  cigarette 
smokers  five  times  as  frequently  as  in 
nonsmokers." 

When  myocardial  infarction  first  mani- 
fests itself  in  sudden  death  or  when  it  is 
truly  silent  the  medical  profession  is  help- 
less, Dr.  Schweizer  said.  But  in  the  other 
cases  medicine  is  not  helpless.  He  recom- 
mends two  ways  in  which  medicine  can 
improve  its  approach  to  this  medical  prob- 
lem: 

1.  "Informing  the  public  concerning  the 
symptoms  that  may  possibly  indicate  myo- 
cardial infarction,  reasonable  measures  to 
take  when  these  symptoms  occur  and  the 
urgency  of  such  measures." 

2.  "Improving  communication  with  medi- 
cal students  and  fellow  physicians  regard- 
ing diagnosis  of  myocardial  infarction." 


458 


Illinois  Medical  Journal 


Clinics  for  Crippled  Children  Scheduled 


Twenty -five  clinics  for  Illinois’  physically 
handicapped  children  have  been  scheduled 
for  November  by  the  University  of  Illinois, 
Division  of  Services  for  Crippled  Children. 
The  Division  will  conduct  twenty-one  gen- 
eral clinics  providing  diagnostic  orthopedic, 
pediatric,  speech  and  hearing  examination 
along  with  medical  social,  and  nursing 
service.  There  will  be  three  special  clinics 
for  children  with  cardiac  conditions  and 
rheumatic  fever,  and  one  for  children  with 
cerebral  palsy.  Clinicians  are  selected  from 
among  private  physicians  who  are  certified 
Board  members.  Any  private  physician  may 
refer  to  or  bring  to  a convenient  clinic  any 
child  or  children  for  whom  he  may  want 
examination  or  consultative  services. 

Nov.  3— Belleville— St.  Elizabeth’s  Hospital 
Nov.  3— Fairfield— Fairfield  Memorial  Hos- 
pital 

Nov.  3— Pittsfield— mini  Community  Hos- 
pital 

Nov.  4— Hinsdale— Hinsdale  Sanitarium 
Nov.  5— Sterling— Community  General 
Hospital 

Nov.  5— Effingham— St.  Anthony  Memorial 
Hospital 

Nov.  5— West  Frankfort— UMWA  Union 
Hospital 

Nov.  6— Chicago  Heights  Cardiac— St. 
James  Hospital 

Nov.  10— Peoria— St.  Francis  Children’s 
Hospital 

Nov.  10— East  St.  Louis— Christian  Welfare 
Hospital 

Nov.  1 1— Champaign-LTrbana  — McKinley 
Hospital 

Nov.  1 1— Joliet— St.  Joseph’s  Hospital 
Nov.  12— Springfield  General— St.  John’s 
Hospital 


Nov.  12— Macomb  — McDonough  District 
Hospital 

Nov.  17— Rock  Island  Area  General— Mo- 
line Public  Hospital 

Nov.  18— Rockford— St.  Anthony  Hospital 
Nov.  18— Centralia— St.  Mary’s  Hospital 
Nov.  18— Evergreen  Park— Little  Company 
of  Mary  Hospital 

Nov.  1 8— Springfield  Pediatric  Neurology- 
Diocesan  Center 

Nov.  19— Decatur— Decatur  Memorial  Hos- 
pital 

Nov.  19— Elmhurst  Cardiac  — Memorial 
Hospital  of  DuPage  County 
Nov.  20— Chicago  Heights  Cardiac— St. 
James  Hospital 

Nov.  24— Peoria— St.  Francis  Children's 
Hospital 

Nov.  24— East  St.  Louis— Christian  Welfare 
Hospital 

Nov.  25— Elgin— Sherman  Hospital 

The  Division  of  Services  for  Crippled 
Children  is  the  official  state  agency  estab- 
lished to  provide  medical,  surgical,  correc- 
tive, and  other  services  and  facilities  for 
diagnosis,  hospitalization  and  after-care  for 
children  with  crippling  conditions  or  who 
are  suffering  from  conditions  that  may  lead 
to  crippling. 

In  carrying  on  its  program,  the  Division 
works  cooperatively  with  local  medical  so- 
cieties, hospitals,  the  Illinois  Children’s 
Hospital-School,  civic  and  fraternal  clubs, 
visiting  nurse  association,  local  social  and 
welfare  agencies,  local  chapters  of  the  Na- 
tional Foundation  and  other  interested 
groups.  In  all  cases,  the  work  of  the  Divi- 
sion is  intended  to  extend  and  supplement, 
not  supplant  activities  of  other  agencies, 
either  public  or  private,  state  or  local,  car- 
ried on  in  behalf  of  crippled  children. 


Publisher  Attacks  Union  Power 

"Inability  of  management  to  control  labor's  insatiable  demands  is  a root  cause 
of  the  inflationary  spiral  we  are  trapped  in  today,  and  it  is  time  the  government 
recognized  it.  It  is  axiomatic  that  higher  wages  cause  higher  prices.  It  is  likewise 
clear  that  as  a consequence  of  overly  protective  labor  laws,  the  pendulum  has 
swung  too  far  to  the  side  of  unionism. 

"For  these  and  other  reasons,  I am  now  calling  on  our  governments  to  initiate 
total  re-examination  of  this  nation's  labor  laws  at  both  the  federal  and  state 
levels,  and  to  revise  and  enact  the  legislation  necessary  to  correct  this  imbalance 
between  management  and  labor."— William  F.  Schmick,  Jr.,  president,  American 
Newspaper  Publishers  Association  and  publisher,  Baltimore  Sun,  in  speech  to 
newspapers'  convention. 


for  October,  1970 


459 


Cellular  Changes  After  Hemorrhagic 
Shock  Can  Cause  Fatal  Lung  Damage 


A soldier  wounded  in  the  leg  by  a mor- 
tar shell  is  treated  and  seems  to  be  recov- 
ering from  the  initial  shock  and  other  ef- 
fects of  his  injury.  His  blood  pressure  re- 
turns to  normal  and  his  condition  appears 
stabilized.  But  he  dies  three  or  four  days 
later  of  respiratory  failure. 

Why? 

According  to  Dr.  James  W.  Wilson  and 
associates,  Duke  University  Medical  Center, 
death  in  such  a case  could  be  the  result 
of  a cellular  chain  reaction  set  up  in  the 
lungs  as  a secondary  response  to  hemor- 
rhagic shock.  Thousands  of  victims  of  auto- 
mobile and  other  accidents  die  each  year 
from  the  initial  effects  of  shock,  and  this 
previously  unsuspected  chain  reaction  may 
account  for  many  additional  fatalities. 

Dr.  Wilson  described  this  sequence  of 
events  as  seen  in  experimental  animals  at 
the  Third  Symposium  of  the  International 
Inflammation  Club  at  Brook  Lodge,  Kala- 
mazoo, Michigan. 

He  identified  it  as  part  of  the  inflamma- 
tory process  by  which  the  body  responds 
to  injury,  and  reported  the  effective  but 
still  experimental  treatment  of  this  pul- 
monary reaction  in  shock-induced  animals 
with  massive  single  injections  of  a steroid 
drug,  methylprednisolone  sodium  succinate 
(Solu-Medrol,  Upjohn).  This  experimental 
treatment  has  not  yet  been  clinically  tested 
in  humans  nor  has  it  been  approved  for 
such  use.  The  steroid  drugs,  he  said,  par- 
tially prevented  or  slowed  the  chain  reac- 
tion which  starts  with  vascular  permeability 
and  the  sticking  or  adherence  of  white 
blood  cells  to  arteries  and  capillaries  in 
the  lungs. 

Although  this  adherence  of  cells  to  vessel 
walls  is  one  of  the  characteristics  of  the 
inflammatory  response.  Dr.  Wilson  said, 
"Certain  aspects  of  the  leukocyte  stickiness 
in  the  pulmonary  vessels  in  hemorrhagic 
shock  are  different  from  the  leukocyte  stick- 


iness of  the  classic  inflammatory  reaction." 

He  pointed  out  that  in  dogs  subjected  to 
hemorrhagic  shock,  these  differences  in- 
cluded failure  of  the  leukocytes  to  emi- 
grate from  the  vessel  or  to  form  the  pseu- 
dopod essential  to  that  action;  they  ad- 
hered more  closely  to  the  walls  and  dif- 
fered in  form  and  cellular  content  from 
those  usually  seen  in  inflamed  tissue. 

"Leukocyte  sequestration  and  fragmen- 
tation in  the  lungs  of  animals  subjected  to 
endotoxin  or  septic  shock  is  a well-known 
phenomenon,"  Dr.  Wilson  said.  "What  re- 
lation endotoxins  or  sepsis  plays  in  the 
pathogenesis  of  the  pulmonary  injury  of 
hemorrhagic  shock  is  not  known." 

He  reported  that  respiratory  failure  has 
been  documented  as  a significant  cause  of 
death  in  soldiers  in  Vietnam  who  have 
suffered  non-thoracic  trauma.  "Changes  in 
the  lungs  of  those  soldiers  are  very  simi- 
lar to  the  changes  observed  in  the  experi- 
mental animal  subjected  to  hemorrhagic 
shock,"  the  investigator  commented. 

Similar  changes  also  have  been  noted 
in  lung  biopsies  from  human  patients  after 
being  placed  on  cardiopulmonary  by-pass, 
he  said. 

These  alterations  in  hemodynamic  hom- 
eostasis, with  increased  vascular  permea- 
bility and  leukocyte  stickiness  resembling 
cellular  events  of  the  inflammatory  reac- 
tion, responded  well  to  Solu-Mendrol  be- 
fore and  after  induction  of  hemorrhagic 
shock  in  experimental  animals.  Dr.  Wilson 
reported. 

"Preliminary  results  are  that  most  of  the 
morphologic  alterations  at  both  the  light 
and  electron  microscopic  level  are  pre- 
vented," he  said.  "The  lung  is  congested 
after  reinfusion  of  the  shed  blood,  but 
there  is  no  hemorrhage  or  extensive  edema 
and  the  sequestration  of  leukocytes  is  re- 
duced." 


As  If  You  Didn't  Know 

Your  child  can  cost  as  much  as  $25,000  to  raise,  depending  on  where  you 
live.  Costs  for  raising  children  to  age  18  range  from  $19,360  in  a rural,  nonfarm 
area  of  the  North  Central  states,  to  $25,000  for  similar  areas  in  the  West. 
The  figures,  released  by  the  Agriculture  Department,  also  indicate  that  it  costs 
45%  more  to  provide  for  an  18-year  old  than  for  a one-year  old. 


460 


lUinois  Medical  Journal 


Drip  Infusion  Urography  Called 
Effective  In  Patients  With 
Poor  Renal  Function 


Satisfactory  and  safe  visualization  of 
the  urinary  tract  has  been  obtained  by 
drip  infusion  urography  with  relatively 
high  doses  of  the  contrast  agent  Hypaque 
in  174  patients  with  reduced  renal  func- 
tion, according  to  a report  in  the  Journal 
of  Urology  (103:267,  1970). 

"The  present  observations  confirm  the 
fact  that  drip  infusion  urography  can  be 
used  successfully  to  visualize  renal  and 
proximal  ureteral  size  when  renal  func- 
tion is  severely  reduced,"  state  Drs.  R.  Dale 
Ensor,  E.  Everett  Anderson  and  Roscoe  E. 
Robinson  of  Duke  University  Medical  Cen- 
ter. 

Emphasizing  the  safety  of  the  procedure, 
the  investigators  say  that  "evidence  sug- 
gests that  the  procedure  exerted  no  ad- 
verse effect  on  renal  function. 

"A  comparison  of  this  technique  with 
that  for  double-dose  urography  demon- 
strated the  greater  diagnostic  usefulness  of 
this  procedure,  especially  in  patients  with 
severe  renal  failure." 

A 50%  solution  of  Hypaque  (sodium 
diatrizoate— Winthrop  Laboratories)  diluted 
with  five  percent  dextrose  in  water  was 
rapidly  infused  intravenously  in  the  174 
patients,  all  of  whom  had  some  form  of 
renal  disease.  X-ray  films  were  made  two 
minutes  after  the  infusion  was  started,  and 
two  minutes  and  10  minutes  after  comple- 
tion. 


Regarding  diagnostic  quality,  the  Duke 
University  team  reports  48%  of  the  uro- 
grams provided  excellent  or  satisfactory 
visualization  of  major  calyces,  renal  pelves 
and  both  ureters.  An  additional  21%  of 
the  urograms  adequately  visualized  kid- 
ney size  and  both  proximal  ureters. 
Twenty-one  percent  of  the  urograms  "were 
comparable  in  quality  to  that  obtained  with 
a good  retrograde  pyelogram,"  the  authors 
note.  Of  considerable  significance,  they 
add,  is  that  53%  of  the  urograms  were 
satisfactory  in  patients  whose  plasma 
creatinine  clearance  ranged  between  five 
and  ten  ml.  per  minute. 

The  few  adverse  reactions  resulting  from 
the  procedure— such  as  nausea,  retching 
and  cutaneous  flushing— were  mild  and  of 
brief  duration.  One  patient  experienced 
mild  and  transient  pulmonary  edema  with 
recumbent  dyspnea. 

"The  present  findings  also  suggest  that 
even  larger  intravenous  doses  of  sodium 
diatrizoate  do  not  exert  an  acutely  adverse 
influence  on  renal  function  per  se  in  azo- 
temic  patients  with  severe  lenal  disease," 
the  report  states. 

While  urging  further  investigation  of  drip 
infusion  urography,  the  authors  conclude 
that  the  procedure  was  "tolerated  ex- 
tremely well  by  all  patients." 


Routine  Urine  Tests 

In  the  absence  of  an  agreed  policy  on  screening  for  disease,  the  respon- 
sibility lies  with  general  practitioner,  public-health  department  and  hos- 
pitals. In  a two-year  period,  about  1000  patients  have  responded  to  a tape- 
recorded  request,  played  at  intervals  in  the  waiting-room,  or  to  postal  or 
health  visitor  follow-up  if  they  had  not  visited  the  surgery.  Thirty-three 
cases  of  glycosuria,  20  of  albuminuria,  and  26  of  hematuria  were  de- 
tected, and  42  patients  are  benefiting  from  treatment  given  as  a result  of 
screening.  Among  the  major  lesions  picked  up  were  diabetes  (15),  carci- 
noma of  the  bladder  (1),  papilloma  of  the  bladder  (2),  and  renal  stone 
(1).  The  screening  program  was  amply  justified  by  the  results;  It  thus  seems 
unfortunate  that  the  Department  of  Health  and  Social  Security  supplies 
other  sections  of  the  Health  Service  with  the  tool  for  screening  but  refuses 
to  provide  diagnostic  strips  free  of  charge  to  general  practitioners.  (Murdo 
Macleod.:  Routine  Urine  Tests  in  General  Practice.  The  Lancet  [May  30] 
1970,  page  1167.) 


for  October,  1970 


461 


Guide  to  Evaluation  of  Permanent  Impairment 
Of  Skin  Available 

The  twelfth  guide  in  the  series,  "Guides  to  the  Evaluation  of  Permanent 
Impairment,"  developed  by  the  Committee  on  Rating  of  Mental  and  Phy- 
sical Impairment  of  the  AMA,  is  now  available. 

The  guide  entitled  "The  Skin,"  like  all  the  others  in  the  series,  has  been 
designed  primarily  for  use  by  physicians.  However,  it  would  be  of  interest 
and  use  to  all  concerned  with  the  medical,  administrative  or  judicial  as- 
pects of  programs  for  the  disabled.  Previously  published  guides  dealt  with 
the  extremities  and  back;  the  digestive  system;  and  the  other  vital  systems. 

The  guide  is  available  without  charge  upon  written  request  to  the 
Committee  on  Rating  of  Mental  and  Physical  Impairment,  535  North  Dear- 
born Street,  Chicago,  III.  60610. 


Wet  Weather  Steer  for  Drivers: 
Accidents  Rise  on  Rainy  Days 

When  rain  reduces  visibility,  highway 
accidents  and  fatalities  mount,  especially 
after  sundown.  Streaky  windshields,  pound- 
ing rain  and  headlight  glare  make  it  hard 
for  drivers  to  see,  and  wet  roads  make  it 
hard  for  them  to  stop.  When  pavements 
are  slick  with  water  and  road  film  caused 
by  oil,  grease  and  dust,  a car  going  30 
miles  an  hour  needs  147  feet  to  stop,  as 
against  88  when  the  road  is  dry.  At  faster 
speeds  "tire  hydroplaning"  can  result— with 
wheels  supported  by  water  alone,  like  a 
skier  crossing  a lake.  When  you  drive  in 
wet  weather,  observe  these  safety  mea- 
sures: 

Slow  down.  On  rainy  days,  play  safe. 
Reduce  speed  at  least  20  per  cent  and  in- 
crease your  braking  interval. 

Turn  on  your  lights,  so  other  drivers  and 
pedestr'ans  can  see  you,  no  matter  how 
hard  the  rain  falls. 

Beware  of  puddles.  Splashing  through  a 
deep  one  can  flood  your  motor,  weaken 
your  brakes,  or  both.  If  fording  is  your 
only  choice,  take  it  slowly;  be  sure  to 
check  your  brakes  when  you  reach  dry 
ground. 

Watch  surface  conditions.  Even  after  rain 
stops,  roads  can  remain  slippery  for  sev- 
eral hours.  Side  streets  can  be  especially 
hazardous. 

Don't  wait  until  it  rains  to  check  your 
windshield  wipers  and  washers.  Keep  the 
defroster  in  repair.  And  always  carry  a rag 
for  wiping  the  glass  inside  and  out. 


Where  Most  Accidents  Occur 

Of  1 15,000  accidental  deaths  during 
1968,  14,300  were  job  related,  about  half 
as  many  as  the  28,500  caused  in  the  home. 
Biggest  killer:  Motor  vehicles,  55,200. 

56,500  lives  were  lost  on  America's  high- 
ways in  1969,  according  to  an  annual  re- 
port from  The  Travelers  Insurance  Com- 
panies. In  addition,  more  than  4,700,000 
men,  women  and  children  were  injured. 


Accident  Pamphlet 

"Place  a child’s  toys,  clothes  and  food 
within  his  reach,  so  he  does  not  have  to 
climb  on  furniture  to  get  them,”  advises  a 
CNA/insurance  executive  in  a new  pam- 
phlet, Preventing  Children’s  Accidents, 
which  cautions  that  falls,  most  of  them  in 
the  home,  kill  hundreds  of  children  every 
year. 

The  booklet  provides  parents  with  15 
pages  of  practical  suggestions  gathered  dur- 
ing a study  of  insurance  files.  It  covers  such 
areas  as  boating,  camping,  sports,  bicycles, 
autos,  and  safety  in  the  home. 

To  obtain  copies  of  Preventing  Children’s 
Accidents,  write:  Children’s  Accidents, 

Booklet  Dept.,  National  Research  Bureau, 
424  N.  Third  St.,  Burlington,  Iowa  52601. 
Copies  are  25  cents  each;  quantity  prices 
available  on  request. 


462 


Illinois  Medical  Jouryial 


Food  for  Thought 


In  May,  1919,  at  Dusseldorf,  Germany, 
the  Allied  Forces  obtained  a copy  of  the 
"Communist  Rules  for  Revolution."  Fifty- 
one  years  later  these  guidelines  are  still 
being  followed.  As  you  read  the  following 
consider  the  world  today.  Maybe  it's  just 
a coincidence.  . . . 

A.  Corrupt  the  young;  get  them  away 
from  religion.  Get  them  interested  in 
sex.  Make  them  superficial;  destroy 
their  ruggedness. 

B.  Get  control  of  all  means  of  publicity, 
thereby: 

1.  Get  people's  minds  off  their  gov- 
ernment by  focusing  their  atten- 
tion on  athletics,  sexy  books  and 
plays  and  other  trivialities. 

2.  Divide  the  people  into  hostile 
groups  by  constantly  harping  on 
controversial  matters  of  no  im- 
portance. 

3.  Destroy  the  people's  faith  in  their 
nation's  leaders  by  holding  them 
up  to  contempt,  ridicule  and  dis- 
grace. 


4.  Always  preach  true  democracy, 
but  sieze  power  as  fast  and  ruth- 
lessly as  possible. 

5.  By  encouraging  government  ex- 
travagance, destroy  its  credit, 
produce  fear  of  inflation  with 
rising  prices  and  general  discon- 
tent. 

6.  Incite  unnecessary  strikes  in  vital 
industries,  encourage  civil  dis- 
orders and  foster  a lenient  and 
soft  attitude  on  the  part  of  gov- 
ernment toward  such  disorders. 

7.  By  specious  argument  cause  the 
breakdown  of  the  old  moral  vir- 
tues, honesty,  sobriety,  self  re- 
straint, faith  in  the  pledged  word, 
ruggedness. 

C.  Cause  the  registration  of  all  fire- 
arms on  some  pretext,  with  a view 
to  confiscating  them  and  leaving  the 
population  helpless. 


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9933  N.  Lawler  Avenue 
Skokie,  Illinois  60076 
Phone:312-679-1000 


for  October,  1970 


463 


Obituaries 

*Max  Bernauer,  Chicago,  died  April  30 
at  the  age  of  77. 

Norman  V.  DeNosaquo,  Chicago,  died 
June  26  at  the  age  of  66.  He  was  director 
of  the  Drug  Utilization  Section  of  the  De- 
partment of  Drugs  of  the  AMA. 

*Hobart  William  Edson,  Rockford,  died 
December  16  at  the  age  of  74.  He  was  a 
member  of  the  ISMS  Fifty-Year  Club. 

*Alonzo  T.  Griffin,  Chicago,  died  April 
22  at  the  age  of  87.  He  was  a member  of 
the  ISMS  Fifty-Year  Club. 

* Richard  D.  Kearney,  Chicago,  died  Au- 
gust 12  at  the  age  of  66. 

* Allan  B.  King,  Chicago,  died  August  21 
at  the  age  of  75.  He  was  chief  medical  ex- 
aminer for  the  Prudential  Insurance  Co., 
and  a member  of  the  ISMS  Fifty-Year  Club. 

^Leonard  A.  Kratz,  McHenry,  died  Febru- 
ary 19  at  the  age  of  68. 

*Harold  Linn,  Chicago,  died  August  24  at 
the  age  of  34.  He  was  an  instructor  at  the 
Chicago  Medical  School. 


*John  W.  Long,  Robinson,  died  April  23 
at  the  age  of  79.  He  was  a member  of  the 
ISMS  Fifty-Year  Club,  and  served  as  sec- 
retary of  the  Crawford  County  Medical  So- 
ciety for  over  40  years. 

* Lawrence  S.  Mann,  Skokie,  died  August 
8 at  the  age  of  53.  He  was  former  co-chair- 
man of  the  Mt.  Sinai  Hospital  Department 
of  Surgery. 

Roger  W.  Poborsky,  Riverside,  died  Au- 
gust 28  at  the  age  of  70.  He  was  a clinical 
professor  of  surgery  at  the  Chicago  Medical 
School. 

*Fred  E.  Scheppler,  Somonauk,  died  Jan- 
uary 14  at  the  age  of  79.  He  was  past  presi- 
dent of  the  DeKalb  County  Medical  Socie- 
ty, and  a member  of  the  ISMS  Fifty-Year 
Club. 

*John  R.  Sharp,  Springfield,  died  August 
10  at  the  age  of  61.  He  was  very  active  in 
various  philanthropic  organizations  in  and 
around  Springfield. 

*J.  Lewis  Vertuno,  Melrose  Park,  died 
January  9 at  the  age  of  51. 

*Maude  H.  Winnett,  Chicago,  died  April 
10  at  the  age  of  85.  She  was  a member  of 
the  ISMS  Fifty-Year  Club. 

*Indicates  member  of  Illinois  State  Medical  Society 


STATEMENT  OF  OWNERSHIP,  MANAGEMENT  AND  CIRCULATION 
(Act  of  October  23,  196S;  Section  4369,  Title  39,  United  States  Code) 


1.  Date  of  Filing:  September  30.  1970. 

2.  Title  of  publication:  Illinois  Medical  Journal. 

3.  Frequency  of  issue:  Monthly. 


10.  Extent  and  Nature  of  circulation. 

Actual  number 
Average  no.  copies  of  copies  of 

each  issue  during  single  issue  published 

preceding  12  months  nearest  to  filing  date 


4.  Location  of  known  office  of  publication:  360  North  Michigan 
Avenue.  Chicago.  Illinois  60601. 


A.  Total  no.  copies  printed 

(Net  Press  Run)  12,500 


12.500  (Sept.  '70) 


5.  Location  of  the  headquarters  or  general  business  offices  of  the 

B. 

Paid  circulation 

publishers  (Not  printers):  360  North  Michigan  Avenue,  Chicago, 

1.  Sales  through  dealers  and 

Illinois  60601. 

carriers,  street  vendors  and 
counter  sales 

None 

6.  Names  and  addresses  of  publisher,  editor,  and  managing  editor: 
Publisher:  Illinois  State  Medical  Society,  360  North  Michigan  Ave., 

2.  Mail  subscriptions 

11,024 

Chicago,  Illinois  60601.  Editor:  T.  R.  Van  Dellen,  M.D.,  360 
North  Michigan  Avenue,  Chicago.  Illinois  60601.  Managing  edi- 

C. 

Total  paid  circulation 

11,024 

tor:  Richard  Ott,  360  North  Michigan  Avenue,  Chicago.  Illinois 
60601. 

D. 

Free  distribution  (including 
samples  by  mail,  carrier  or 
other  means 

679 

7.  Owner  (If  owned  by  a corporation,  its  name  and  address  must 
be  stated  and  also  immediately  thereunder  the  names  and  addresses 
of  stockholders  owning  or  holding  1 percent  or  more  of  total 

E. 

Total  distribution  (Sum  of 
C and  D) 

11,703 

amount  of  stock.  If  not  owned  by  a corporation,  the  names  and 
addresses  of  the  individual  owners  must  be  given.  If  owned  by  a 
partnership  or  other  unincorporated  firm,  its  name  and  address, 
as  well  as  that  of  each  individual  must  be  given.)  None. 

F. 

Office  use.  left-over. 

unaccounted,  spoiled  after 

797 

printing 

8.  Known  bondholders,  mortgagees,  and  other  security  holders 
owning  or  holding  1 per  cent  or  more  of  total  amount  of  bonds, 
mortgages  or  other  securities  (If  there  are  none,  so  state) : None. 

G. 

TOTAL  (Sum  of  E & F— 
should  equal  net  press  run 
shown  in  A) 

12.500 

None 

11,254 

11,254 


593 

11,847 


653 


12,500 


9.  For  completion  by  nonprofit  organizations  authorized  to  mail  at 
special  rates  (Section  132.122,  Postal  Manual).  The  purpose,  func- 
tion, and  nonprofit  status  of  this  organization  and  the  exempt 
status  for  Federal  Income  tax  purposes  have  not  changed  during 
preceding  12  months. 


I certify  that  the  statements  made  by  me  above  are  correct  and 
complete.  (Signature  of  editor,  publisher,  business  manager,  or 
owner) 

John  A.  Kinney,  Business  Manager 


464 


Illinois  Medical  Journal 


New  Pharmaceuticals 

(Continued  from  page  457) 

Dosage:  Apply  twice  daily  with  sxifficient  cream 
or  solution  to  cover  lesion.  Continue  medication 
until  inflammatory  reaction  reaches  the  ero- 
sion, necrosis  and  ulceration  stage.  Usual  dura- 
tion— 2-4  weeks. 

Supplied:  Solution,  10  cc  drop  dispensers,  2%  or 
5%  weight/weight 
Cream,  25  gm.  tube,  5% 

QUINETTTE  An tiinfectives- Vaginal 
VAGINAL  CREAM 

Manufacturer:  Arnar-Stone 

Composition:  Each  4 gm.  contains: 

Diiodohydroxyquin  100  mg. 

Sulfadiazine  500  mg. 

Diethylstilbestrol  0.1  mg. 

Indications:  Wide  variety  of  vaginal  infections. 

Contraindications:  Allergy  to  oral  therapy  with 
sulfonamides.  Familial  history  of  genital  carci- 
noma or  evidence  of  precancerous  lesions. 

Dosage:  Insert  1/2  applicator  full  (4  gm.)  high  in 
posterior  fornix  upon  retiring.  Continue  treat- 
ment for  12  days. 

Supplied:  Tube  with  applicator,  96  gm. 


Larodopa^  ™ by  Roche^ 
Available  throughout  U.S. 

Larodopa^''''— the  Roche  brand  of  levodo- 
pa— is  now  available  for  general  prescrip- 
tion use  throughout  the  United  States.  Pa- 
tients suffering  from  Parkinson’s  Disease 
and  Syndrome,  regardless  of  where  they 
live,  will  be  able  to  receive  the  benefits  of 
this  new  therapeutic  agent.  Approximately 
one  million  patients  in  the  United  States 
are  believed  to  be  suffering  from  Parkin- 
son’s with  50,000  new  victims  diagnosed 
each  year. 

Larodopa  (levodopa)  is  available  in  both 
tablets  and  capsules,  in  two  strengths:  0.5 
Gm  and  0.25  Gm. 

The  0.5  Gm  tablets  are  pink,  capsule- 
shaped, biconvex,  and  scored;  they  are  im- 
printed “Roche-56.” 

The  0.25  Gm  tablets  are  pink,  round,  flat, 
bevel-edged  and  scored;  they  are  imprinted 
“Roche-57.” 

The  0.5  Gm  capsules  are  pink,  hard-shell, 
two  piece  capsules,  imprinted  “Roche-54.” 

The  0.25  Gm  capsules  are  two  piece, 
hard-shell  capsules,  imprinted  “Roche-55.” 
The  capsule  body  is  beige  and  the  cap  is 
pink. 

For  detailed  information  on  dosage,  ad- 
ministration, precautions,  side  effects,  and 
contraindications,  the  attached  package  in- 
sert should  be  consulted. 


Dedicated  to  Progressive  Psychiatry 
and  Oriented  to  Short  Term 
Hospitalization  and  Treatment 


"MAN  IS  NOT  SOUL  OR  BODY,  BUT  THESE 
TWO  SUBSTANCES  INMOSTLY  UNITED" 


Psychological  and  Physiological  ther- 
apies for  the  neuroses,  psychoses  and 
psychosomatic  disorders,  with  special 
emphasis  on  INSULIN  DEEP  COMA 
THERAPY  for  the  schizophrenias  and 
the  newly  developed  INDOKLON 
THERAPY  for  the  depressions. 

FOR  ADOLESCENTS:  Quality  care  with 
specialized  programs  including  ac- 
credited schooling. 

Phone:  312-878-9700 
4840  NORTH  MARINE  DRIVE 
CHICAGO,  ILLINOIS  60640 

J.  Dennis  Freund,  M.D.,  Medical  Director 


for  October,  1970 


465 


Taste! 


Dicarbosil 

ANTACID 


Your  ulcer  patients  and 
others  will  love  it.  Specify 
DICARBOSIL  144  S-144  tab- 
lets in  12  rolls. 


ARCH  LABORATORIES 

319  South  Fourth  Street.  St.  Louis,  Missouri  63102 


i 


COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 
STARTING  DATES— 1970 

SPECIALTY  REVIEW  COURSE  IN  OB/GYN,  October  19 
SPECIALTY  REVIEW  COURSE  IN  SURGERY.  PART  I,  Oct.  19 
SPECIALTY  REVIEW  COURSE  IN  UROLOGY,  Three  Days, 
Oct.  14 

SPECIALTY  REVIEW  COURSE  FOR  FAMILY  PRACTICE,  Nov.  2 
SPECIALTY  REVIEW  COURSE  IN  MEDICINE.  PART  II.  Nov.  16 
SPECIALTY  REVIEW  COURSE  IN  ORTHOPEDICS,  Nov.  16  & 
Dec.  7 

AMPUTATION  SURGERY  & REHABILITATION,  2V2  Days,  Oct. 
22 

SURGERY  OF  COLON  & RECTUM,  One  Week,  October  26 
BLOOD  VESSEL  SURGERY,  One  Week,  November  2 
BASIC  OBSTETRICS,  One  Week,  No, ember  16 
BASIC  GYNECOLOGY.  One  Week,  November  30 
SURGICAL  & RADIATION  THERAPY  OF  GYNE.  MALIGNAN- 
CIES, Nov.  30 

VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  De- 
cember 14 

UROLOGY  FOR  GENERAL  PRACTITIONERS,  Two  Days,  Nov.  19 
ADVANCES  IN  MEDICINE,  One  Week,  November  30 
GENERAL  PEDIATRICS,  One  Week,  November  30 
RADIOISOTOPES,  One  or  Two  Weeks,  Request  Dates 
INTERMEDIATE  CARDIOLOGY,  41/2  Days,  October  26 
INHALATION  & REGIONAL  ANESTHESIA,  Request  Dates 

Information  concerning  numerous  other 
continuation  courses  available  upon  request. 

TEACHING  FACULTY 

Attending  Staff  of 
Cook  County  Hospital 

Address: 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 


Family  Practice  exam  slated 

The  American  Board  of  Family  Practice 
announces  that  it  will  give  its  second  ex- 
amination for  certification  in  various  cen- 
ters throughout  the  United  States.  The  ex- 
amination will  be  over  a two-day  period 
on  February  27-28,  1971. 

Information  regarding  the  examination 
and  eligibility  can  be  obtained  by  writing: 
Nicholas  J.  Pisacano,  M.D.,  secretary-treas- 
urer, American  Board  of  Family  Practice, 
Inc.,  University  of  Kentucky  Medical  Center, 
Annex  #2,  Room  229,  Lexington,  Kentucky 
40506. 

The  deadline  for  receiving  completed  ap- 
plications is  November  1,  1970. 


Wh/  E.  Coli  Attack  Kidney  Under 
Study 

The  problem  of  why  certain  bacteria  at- 
tack only  specific  organs  is  being  studied 
by  a University  of  Chicago  scientist. 

Dr.  Floyd  A.  Fried,  assistant  professor 
of  surgery  in  the  University's  Division  of 
Biological  Sciences  and  The  Pritzker  School 
of  Medicine,  is  working  with  A.  Philip  De 
Pauw  and  Michael  Ginsburg,  students  in 
the  Pritzker  School,  examining  the  mechan- 
isms in  which  a particular  bacteria,  E.  coli, 
attack  and  injure  the  kidney. 

"About  75%  of  all  infections  of  the 
urinary  tract  can  be  attributed  to  E.  coli," 
Dr.  Fried  stated. 

Certain  E.  coli  can  attack  and  destroy  the 
membrane  that  surrounds  red  blood  cells. 
Dr.  Fried's  research,  supported  by  the  U.S. 
Public  Health  Service,  indicates  that  these 
same  types  also  attack  and  destroy  the 
membrane  surrounding  an  intracellular 
enzyme  storing  structure,  the  lysosome. 

Destruction  of  this  lysosomal  membrane 
releases  enzymes,  used  to  break  down 
proteins  and  other  complex  molecules  to 
simpler  forms  that  can  be  used  to  supply 
cell  energy.  These  liberated  enzymes  may 
then  attack  and  destroy  the  cell.  The  dead 
cell  then  provides  a breeding  place  for 
more  bacteria,  and  the  process  escalates 
into  a kidney  infection  known  as  pyelo- 
nephritis. 

F.  coli  normally  reside  in  the  intestine. 
They  may  enter  the  urinary  tract  through 
the  bloodstream  and  lymphatic  system  or 
may  directly  ascend  through  the  urinary 
tract  itself. 


465 


Illinois  Medical  Joimial 


Illinois  Medical  Journal 

volume  138,  nutnber  5 november,  1970 


IMIJ 


Editor  

Managing  Editor  

Editorial  Assistant  

Advertising  Manager  ... 
Executive  Administrator 


.Theodore  R.  Van  Dellen,  M.D. 

Richard  A.  Ott 

Michaelyn  Sloan 

John  A.  Kinney 

Roger  N.  White 


CONrE^iTS 


ILLINOIS  STATE 
MEDICAL  SOCIETY 

360  N.  Michigan  Ave.,  Chicago/  60601 


OFFICERS 

J.  Ernest  Breed,  President 
55  East  Washington  Street,  Chicago  60602 
1.  T.  Fruin,  President-Elect 
5 Citizen's  Square,  Normal,  61761 
George  C.  Shropshear,  1st  Vice-President 
1525  East  53rd  Street,  Chicago,  60615 
C.  J.  Jannings,  III,  2nd  Vice-President 
101  East  Center  Street,  Foirfield,  62837 
Jacob  E.  Reisch,  Secretary-Treasurer 

1129  South  2nd  Street,  Springfield  62704 
Poul  W.  Sunderland,  Speaker 
214  North  Sangamon  St.,  Gibson  City,  60936 
Andrew  J.  Brislen,  Vice-Speaker 
6060  South  Drexel  Blvd.,  Chicago  60637 
Willard  C.  Scrivner,  Chairmen  of  the  Board 
4601  State  Street,  East  St.  Louis,  62205 


CLINICAL  ARTICLES 

Encephalitis  with  catatonic  schizophrenic  symptoms 


Chang  Hwan  Kim,  M.D.,  and  Meyer  A.  Perlstein,  M.D 503 

The  wound  that  killed  Lincoln 

Jolm  ImI timer,  M.D.  514 

Giant  fibroma  (Fibromatosis)  of  mesentery 

Henry  P,  Lattuada,  MJ).,  Mario  Stefanini,  M.D.  and 

Lewis  C.  Powell,  M.D 518 

Pathology  of  ocular  trauma 

Milton  M.  Scheffler  522 

Medical  care  of  the  elderly  patient 

Bertram  B.  Moss,  M.D 527 

SURGICAL  GRAND  ROUNDS 

Acoustic  neuroma  509 


TRUSTEES 

Joseph  L.  Bordenave,  1st  District  (1971) 

1665  South  Street,  Geneva,  60134 
William  A.  McNichols,  Jr.,  2nd  District  (1971) 
101  West  First  Street,  Dixon,  61021 
Fredric  D.  Lake,  3rd  District  (1972) 

1041  Michigan  Avenue,  Evanston,  60202 
James  B.  Hartney,  3rd  District  (1973) 

410  Lake  Street,  Oak  Park,  60302 
Frank  J.  Jirka,  3rd  District  (1971) 

1507  Keystone  Ave.,  River  Forest,  60305 
William  M.  Lees,  3rd  District  (1971) 

6518  N.  Nokomis,  Lincolnwood,  60646 
Frederick  E.  Weiss,  3rd  District  (1973) 

15643  Lincoln  Avenue,  Harvey,  60426 
Warren  W.  Young,  3rd  District  (1972) 

10816  Parnell  Avenue,  Chicago,  60628 
Fred  Z.  White,  4th  District  (1973) 

723  North  Second  St.,  Chillicothe,  61523 
A.  Edward  Livingston.  5th  District  (1973) 

219  North  Main,  Bloomington,  61701 
J.  Mather  Pfetffenberger,  6 District  (1972) 

State  & Wall  Streets,  Alton,  62002 
Arthur  F.  Goodyear,  7th  District  (1973) 

142  East  Prairie  Avenue,  Decatur,  62523 
Eugene  P.  Johnson,  8th  District  (1973) 

22  West  Main  Street,  Casey,  62420 
Charles  K.  Wells,  9th  District  (1972) 

117  North  10th  Street,  Mt.  Vernon,  62864 
Willard  C.  Scrivner,  10th  District  (1972) 

4601  State  Street,  East  St.  Louis,  62205 
Joseph  R.  O'Donnell,  11th  District  (1971) 

444  Park,  Glen  Ellyn,  60137 
Edward  W.  Cannady,  Trustee-at- Large 
4601  State  Street,  Eost  St.  Louis,  62205 


Microfilm  copies  of  current  as  well  as  some  back 
issues  of  the  Illinois  Medical  Journal  may  be 
purchased  from  Xerox  University  Microfilms,  300 
N.  Zeeb  Road.  Ann  Arbor.  Mich.,  48106. 


SPECIAL  ARTICLES 

Supreme  Court  decision  in  hepatitis  case 


Frank  M.  Pfeifer,  Counsel,  ISMS  532 

The  plans  of  our  doctors  in  training 

7.  Ernest  Breed,  M.D.,  ISMS  president  536 

In  Will  and  Grundy  Counties— Pilot  project  in  medical 
review  successfully  completed  542 

FEATURES 

Blue  Shield  Report  . 471 

Clinics  for  Crippled  Children  489 

The  President’s  Page  494 

The  View  Box  508 

The  Doctor’s  Library  526 

New  Pharmaceutical  Specialties  534 

Editorials 538 

Illinois  Medical  Assistants  Association  540 

Physicians’  Placement  Service  .541 

Socio-Economic  News  547 

Meeting  Memos  .552 

Obituaries  558 

(Cover  story  on  page  480) 


Published  monthly  by  the  Illinois  State  Medical 
Society,  360  N.  Michigan  Ave.,  Chicago,  III.,  60601. 
Copyright  1970,  The  Illinois  State  Medical  Society. 

Subscription  $5.00  per  year,  in  advance,  postage 
prepaid,  for  the  United  States,  Cuba,  Puerto  Rico. 
Philippine  Islands  and  Mexico.  $7.50  per  year  for 
all  foreign  countries  included  in  the  Universal  Postal 
Union.  Canada  $5.50  U.S.  Single  current  copies 
available  at  75c. 

Second  class  postage  paid  at  Chicago.  111.  and  at 
additional  mailing  offices.  When  moving  please  notify 


Journal  oCBce  of  new  address  including  old  mailing 
label  with  notification,  if  possible.  POSTMASTER: 
Send  notice  on  form  No.  3579  to  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave.,  Chicago, 
111.  60601. 

Pharmaceutical  advertising  must  be  approved  by 
the  ISMS  Publications  Committee.  Other  advertising 
accepted  after  review  by  Publications  Committee  or 
Board  of  Trustees.  All  copy  or  plates  must  reach  the 
Journal  office  by  the  fifteenth  of  the  month  preceding 
publication.  Rates  furnished  upon  request. 


Original  articles  will  be  considered  for  publication 
with  the  understanding  that  they  are  contributed  only 
to  the  Illinois  Medical  Journal.  The  ISMS  denies 
responsibility  for  opinions  and  statements  expressed  by 
authors  or  in  excerpts,  other  than  editorial  or  allied 
views  or  statements  which  reflect  the  authoritative 
action  of  the  ISMS  or  of  reports  on  official  actions, 
policies  or  positions.  Views  expressed  by  authors  do 
not  necessarily  represent  those  of  the  Society;  any 
connection  with  oflScial  policies  Is  coincidental. 


for  November,  1970 


475 


Blue  Shield  Offers 
Alcohol  Program 

Blue  Shield  has  developed  a new  program  to  com- 
bat alcoholism  which  includes  a one-hour,  two-part 
film  produced  for  television,  a half-hour  radio  pro- 
gram and  a 40  page  full-color  booklet. 

The  film,  entitled  “The  Other  Guy,”  is  a drama- 
documentary based  on  the  life  of  a young  business 
executive. 

It  stars  Ben  Piazza  who  relives  situations  that 
lead  to  his  becoming  an  alcoholic.  The  film  in- 
cludes brief  interviews  with  recovered  alcoholics 
and  authorities  on  alcoholism.  Among  those  inter- 
viewed are  Senator  Harold  Hughes,  chairman  of  the 
Senate  Subcommittee  On  Alcoholism  and  Narcotics, 
and  Dr.  Roger  Egeberg  of  the  Department  of 
Health,  Education  and  Welfare. 

The  half-hour  radio  programs  feature  interviews 
with  alcoholism  authorities  and  actual  alcoholics. 

The  film,  programs  and  booklets,  produced  by  the 
National  Association  of  Blue  Shield  Plans,  will  be 


made  available  after  January  1,  1971,  by  the  Blue 
Shield  Plan  of  Illinois  Medical  Service.  For  addi- 
tional information  contact: 

Public  AfFairs  Department 
Illinois  Blue  Shield 
222  North  Dearborn  Street 
Chicago,  Illinois  60601 
Phone:  312-661-3071 

British  Private  Health 
Insurance  Grows 

Blue  Shield’s  new  aflBliate  in  England  has  an- 
nounced that  60,000  more  Britains  elected  to  be 
protected  by  their  private  health  care  coverage  dur- 
ing 1969.  The  British  United  Provident  Association 
(BUPA)  reported  that  as  of  December  31,  1969,  it 
had  701,000  subscribers,  representing  more  than  1.5 
million  members.  BUPA  pays  for  covered  health 
care  services,  on  a private  basis,  to  individuals  and 
groups  who  seek  an  alternative  to  the  British  Na- 
tional Health  System. 


Takes  Over  fn  November^  ’71 

NEW  NABSP  PRESIDENT  NAMED 


Ned  F.  Parish,  Executive  Vice  President  of  the 
National  Association  of  Blue  Shield  Plans  (NABSP), 
has  been  designated  to  become  president  when 
John  W.  Castellucci  retires  next  year. 

In  an  announcement  released  from  Chicago  head- 
quarters, Ira  C.  Layton,  M.D.,  of  Kansas  City,  Mis- 
souri, chairman  of  the  National  Association  of  Blue 
Shield  Plans,  said: 

“By  designating  Mr.  Parish  at  this  time  as  the  one 
who  will  succeed  Mr.  Castellucci  as  president  when 
he  retires  on  November  1,  1971,  we  will  assure  the 
association  of  continuity  in  our  top  management.” 

Castellucci,  who  recommended  the  need  for  a 
plan  of  succession,  said: 

“We  are  facing  many  critical  issues  in  health  care 
\ financing.  It  is  essential  that  we  have  a strong  and 
J consistent  approach  to  meeting  them,  and  Ned 
Parish  will  be  able  to  provide  the  needed  adminis- 
trative leadership.” 


Parish,  an  outstanding  administrator  in  the  health 
care  prepayment  field  for  more  than  a quarter  of  a 
century,  has  been  executive  vice  president  of  the 
association  since  1967. 

He  began  his  prepayment  career  in  1939  in  Cleve- 
land. In  1947,  he  played  a key  role  in  the  establish- 
ment of  the  Arizona  Blue  Shield  Plan  and  was 
named  assistant  director  of  Arizona  Blue  Shield  and 
Blue  Cross  in  1949. 

Parish  was  named  assistant  director  of  the  Blue 
Shield  Plans,  the  forerunner  of  the  National  Asso- 
ciation of  Blue  Shield  Plans,  in  1953. 

Castellucci  has  been  chief  executive  officer  of 
NABSP  since  1955.  At  that  time  the  association  had 
7 employees,  and  Blue  Shield  Plans  covered  34  mil- 
lion persons. 

Today,  the  national  office  has  100  employees,  and 
there  are  65  million  people  enrolled  in  the  73  Blue 
Shield  Member  Plans. 


(This  is  not  an  advertisement) 


ASSIGNMENTS: 


WHAT  THE  PHYSICIAN 


SHOULD  KNOW 


Questions  are  often  asked  about  Medicare  assign- 
ments. Basically,  it  is  one  of  two  methods  of  pay- 
ments that  Medicare  allows.  When  the  doctor  bills 
the  patient,  payment  will  be  made  to  the  patient. 
This  is  direct  billing.  However,  payment  can  be 
made  directly  to  the  physician  when  he  accepts 
assignment.  The  choice  of  which  method  to  use  is 
left  to  the  physician  if  he  bills  his  patient  directly 
or  to  the  physician  and  patient  when  he  accepts 
assignment. 

When  a physician  and  his  patient  agree  to  the 
assignment,  the  physician  agrees  that  the  reasonable 
charge  determined  by  the  Part  B Medicare  carrier 
will  be  payment  in  full  and  that  his  charge  to  the 
patient  will  be  no  more  than  the  20  percent  coin- 
surance rate  of  the  reasonable  charge  and  any  por- 
tion of  the  unmet  $50.00  deductible.  Medicare  will 
pay  the  other  80  percent.  However,  the  physician 
may  bill  the  patient  for  any  services  not  covered  by 
Medicare. 


ASK  BLUE  SHIELD 


• • • ABOUT  MEDICARE 

Labs  Outside  Your  Office 
Must  Be  Identified 

Whenever  a physician  submits  a claim  for  an 
office  visit  which  includes  charges  for  laboratory 
tests  made  outside  his  office,  the  laboratory  must 
by  identified  on  the  SSA-1490,  Medicare  Claim  for 
Payment  form. 

If  the  laboratory  is  not  approved,  the  claim  for 
laboratory  services  must  be  denied.  However,  this 
does  not  aflfect  the  coverage  of  the  office  visit  which 
usually  includes  the  physician’s  charge  for  evaluat- 
ing and  interpreting  the  laboratory  report.  These 
will  be  covered  in  the  usual  manner,  regardless  of 
whether  the  laboratory  claim  is  paid  or  denied. 


The  agreement  to  accept  an  assignment  for  one 
patient  does  not  obligate  the  physician  to  accept 
the  assignment  for  his  other  patients,  nor  for  that 
same  patient  for  a later  service. 

If  the  physician  accepts  assignment,  he  should  ob- 
tain the  necessary  information  from  the  patient  to 
complete  Part  I,  items  1 through  6 of  the  SSA  1490, 
Request  for  Payment  form  and  obtain  the  signature 
of  the  patient  on  the  form  in  item  6.  The  physician 
or  his  office  assistant  must  provide  the  remaining 
information  in  Part  II  of  the  form. 

The  claim  form  must  be  complete,  including 
the  signatures  of  the  patient  and  physician  in  every 
assignment  claim.  Be  sure  to  check  mark  in  the  item 
12  “I  accept  assignment”  box,  to  show  that  the 
physician  and  his  patient  have  agreed  to  the  assign- 
ment. If  the  box  is  not  checked,  payment  will  be 
made  to  the  patient. 

To  avoid  unnecessary  delays  in  payment,  be  sure 
to  include  the  following  information: 

1.  Date  of  service; 

2.  Place  where  service  was  performed  (hospital, 
office,  home,  etc.); 

3.  Description  of  service; 

4.  Nature  of  illness  or  injury; 

5.  Charge  for  each  service. 

SSA  Certifies 
New  Laboratories 

The  following  laboratories  have  been  certified 
for  Medicare  participation  by  the  Social  Security 
Administration: 

Campos  Laboratory 

1608  North  Milwaukee  Avenue 

Chicago,  Illinois  60647 

Illinois  Valley  Diagnostic  Laboratory 

1609  Fourth  Street 

Peru,  Illinois  61354 

Northwest  Medical  Laboratories 

2006  West  Chicago  Avenue 

Chicago,  Illinois  60622 


(This  is  not  an  advertisement) 


The  actions  of  the  official 
Tincture  and  Extract  of 
Belladonna  result  chiefly  from 
their  Atropine  content . . . 
conclude  Goodman  and  Gilman 


THE  PHARMACOLOGICAL  BASIS  OF  THERAPEUTICS 
3rd  Edition,  page  522 


Antrocol  provides  the  prompt,  predictable  antisecretory  action  of  the  bella^ 
donna  alkaloid,  atropine,  fortified  with  sedation  and  blended  with  BensuU 
foid,  contributing  to  even  absorption. 


Each  tablet  or  capsule  contains: 
Atropine  sulfate,  0.324  mg.;  Phe- 
nobarbital,  16  mg.  (may  be  habit 
forming);  Bensulfoid,  65  mg.  (see 
white  section  PDR).  The  atropine 
content  of  Antrocol  is  the  maxi- 
mum amount  the  average  patient 
can  take  at  six  hour  intervals  over 
long  periods  with  comfort. 

SUPPLIED 

Tablet  in  bottles  of 
100,  500  and  5000 
Capsule  in  bottles 
of  100, 500  and  1000 

Caution:  Federal  law  prohibits 
dispensing  without  prescription. 


Prescribing  Information 
Contraindicated  in  glaucoma.  Use  cautiously  in  pro- 
static hypertrophy.  Side-effects  of  toxic  dose  of 
atropine:  flushing,  dryness  of  mouth,  cycloplegia, 
tachycardia  and  urinary  retention. 

Dosage:  One  tablet  or  capsule  after  each  meal  to 
correct  emotional  stress  and  normalize  gastric  se- 
cretions. In  treating  peptic  ulcer,  doses  at  regular 
intervals  up  to  eight  (8)  tablets  or  capsules  per  day 
to  provide  the  proper  gastric  titer  for  healing.  After 
ulcer  has  healed,  one  tablet  or  capsule  after  each 
meal  to  maintain  a titer  unfavorable  to  recurrence. 

Clinical  supply  available  to  physicians. 

WILLIAM  P.  POYTHRESS  & CO.,  INC. 

RICHMOND,  VIRGINIA  23217 


ISMS  news 


Legislative  KEY-MAN  program  created 


The  ISMS  Public  Affairs  Committee  re- 
cently approved  the  development  of  a new 
and  exciting  legislative  KEY-MAN  jDrogTam. 

The  KEY-MAN  program  was  created 
with  the  thought  in  mind  that  a good  deal 
of  past  legislative  effectiveness  and  success 
can  be  attributed  to  grass  roots  physician 
participation.  The  importance  of  a per- 
sonal physician/legislator  relationship  can- 
not be  over  emphasized. 

This  new  plan  calls  for  at  least  one  phy- 
sician to  be  assigned  to  each  of  the  2-1  Illi- 
nois Congi'essmen,  58  State  Senators,  and 
177  Representatives.  Needless  to  say,  the 
designated  KEY-MAN  must  be  a constituent 
of  the  Legislator,  and  hopefully  he  knows 
or  will  get  to  know  his  Legislator  on  a first 
name  basis.  He  will  communicate  with  his 
legislator  regularly  so  that  the  legislator 
knows  exactly  where  medicine  stands  on 
various  issues.  The  ISMS  Legislative  Divi- 
sion will  be  in  constant  contact  with  the 
KEY-MAN  through  various  means— placing 
him  on  a special  mailing  list  to  receive 
legislative  alerts— regular  issues  of  On  The 
Legislative  Scene  during  the  Legislative 
Session— via  tclegTam  or  telephone. 

In  matters  of  state  legislation,  the  con- 
trol by  one  political  party  in  the  Legisla- 
ture lias  never  had  too  significant  an  effect 
on  the  outcome  of  the  Medical  Society’s 
legislative  progiam.  We  have  many  friends 
on  both  sides  of  the  aisle.  Through  this 
new  .system  we  hope  to  communicate  more 
effectively  with  all  Illinois  legislators  re- 
gardless of  party  affiliation. 

Are  you  personally  acquainted  with  one 


or  more  of  our  Legislators?  Perhaps  you 
are  the  personal  physician  of  a Legislator! 
If  so,  you  are  urged  to  submit  this  informa- 
tion to  the  ISMS  Legislative  and  Public 
Affairs  Division,  Regional  Office,  and  volun- 
teer your  services  as  a KEY-MAN.  The  suc- 
cess of  this  new  and  challenging  program 
cair  only  be  achieved  through  the  efforts 
of  a large  number  of  physicians  who  are 
willing  to  take  the  time  to  become  informed 
on  legislative  and  public  affairs  matters 
and  ACT. 

KEY-MAN  SYSTEM  QUESTIONNAIRE 

.^re  you  personally  acquainted  with  your  Con- 
gressman, State  Senator  or  Representative? 

yes  no 

If  so,  please  give  names  


.-\re  you  the  personal  physician  of  a I.egislator? 

yes  no 

If  so,  please  give  name  

Would  you  be  willing  to  serve  as  a KEY-MAN  for 
one  or  more  Legislators? 

yes  no 

If  so,  please  list  names:  


If  YOU  are  not  willing  to  serve  in  this  capacity, 
please  recommend  other  physicians  from  your  area: 


name  & address  Legislator 


name  &:  address  Legislator 

Your  name  

Address  

street,  city,  zip 


Telephone  No 

Return  to:  John  Ovitz,  M.D.,  Chairman 
Public  Affairs  Committee 
Illinois  State  Medical  Society 
Regional  Office 
520  So.  6th  Street 
Springfield,  Illinois  62701 


ON  THE  COVER 

This  month's  cover  is  probably  best  described  in  lyrics  from  o song  of  the  1940's,  "Tis 
Autumn." 

"The  trees  say  they're  tired,  they've  borne  too  much  fruit. 

Charmed  on  the  wayside,  there's  no  dispute; 

Now  shedding  leaves,  they  don't  give  a hoot, 

Tis  Autumn. 

Cover  art  by  Mike  Ahearn. 


480 


JUinois  Medical  Journal 


Clinics  for  Crippled  Children  Scheduled 


Twenty-four  clinics  for  Illinois’s  phys- 
ically handicapped  children  have  been 
scheduled  for  December  by  the  University 
of  Illinois,  Division  of  Services  for  Crippled 
Children.  The  Division  will  count  seven- 
teen general  clinics  providing  diagnostic 
orthopedic,  pediatric,  speech  and  hearing 
examination  along  with  medical  social, 
and  nursing  service.  There  will  be  five 
special  clinics  for  children  with  cardiac 
conditions  and  rheumatic  fever,  and  two 
for  children  with  cerebral  palsy.  Clinicians 
are  selected  from  among  private  physicians 
who  are  certified  Board  members.  Any 
private  physician  may  refer  to  or  bring 
to  a convenient  clinic  any  child  or  children 
for  whom  he  may  want  examination  or 
consultative  services. 

December  1 Alton— Alton  Memorial  Hos- 
pital 

December  2 Carmi— C a r m i Township 
Hospital 

December  2 Hinsdale— Hinsdale  Sanitar- 
ium 

December  2 Rock  Island  Cerebral  Palsy- 
3808  Eighth  Avenue 

December  3 Effingham— St.  Anthony  Me- 
morial Hospital 

December  3 Litchfield-M  a d i s o n Park 
School 

December  3 Lake  County  Cardiac— Vic- 
tory Memorial  Hospital 
December  3 Springfield  Genera  1— St. 
John’s  Hospital 

December  4 Chicago  Heights  Cardiac— 
St.  James  Hospital 

December  8 Peoria— St.  Erancis  Children’s 
Hospital 

December  8 East  St.  Louis— Christian 
Welfare  Hospital 

December  9 Champaign-Urbana— McKin- 
ley Hospital 

December  15  Belleville  — St.  Elizabeth’s 
Hospital 


December 

December 

December 

December 

December 

December 

December 

December 

December 

December 

December 


15  Rock  Island  Area  General— 
Moline  Public  Hospital 

16  Chicago  Heights  General— 
St.  James  Hospital 

16  Springfield  Pediatric  Neu- 
rology-Diocesan Center 

16  Aurora— Copley  Memorial 
Hospital 

17  Rockford— Rockford  Memor- 
ial Hospital 

17  Bloomington— St.  Joseph’s 

Hospital 

17  Elmhurst  Cardiac— Memorial 
Hospital  of  DuPage  County 

18  Chicago  Heights  Cardiac— 
St.  James  Hospital 

18  Evanston— St.  Erancis  Hos- 
pital 

21  Peoria  Cardiac— St.  Erancis 
Children’s  Hospital 

22  Peoria— St.  Erancis  Chil- 

dren’s Hospital. 


The  Division  of  Services  for  Crippled 
Children  is  the  official  state  agency  estab- 
lished to  provide  medical,  surgical,  correc- 
tive, and  other  services  and  facilities  for 
diagnosis,  hospitalization  and  after-care 
lor  children  with  crippling  conditions  or 
who  are  suffering  from  conditions  that 
may  lead  to  crippling. 

In  carrying  on  its  program,  the  Division 
works  cooperatively  with  local  medical  so- 
cieties, hospitals,  the  Illinois  Children’s 
Hospital-School,  civic  and  fraternal  clubs, 
visiting  nurse  association,  local  social  and 
welfare  agencies,  local  chapters  of  the  Na- 
tional Foundation  and  other  interested 
groups.  In  all  cases,  the  work  of  the  Division 
is  intended  to  extend  and  supplement,  not 
supplant  activities  of  other  agencies,  either 
public  or  private,  state  or  local,  carried 
on  in  behalf  of  crippled  children. 


The  Danger  in  More  Taxes 

"Approximately  35  to  37%  of  the  total  income  of  the  United  States  goes 
to  federal,  state  and  local  taxes.  I believe  that  amount  is  high  enough.  I 
believe  that  when  a nation  takes  a substantially  larger  portion  of  the  na- 
tional income  than  that  for  taxes,  that  nation  loses  its  character  as  a free 
private  enterprise  economy  and  becomes  primarily  a state-controlled  and 
oriented  economy."  President  Richard  M.  Nixon. 


for  November,  1970 


489 


The  patient  who  has  had  a myocardial 
infarction  is  usually  advised  by  his 
physician  to  avoid  emotional  excitement. 
All  too  often  his  family,  acutely 
concerned,  transmits  its  anxiety  to  him, 
urging  him  to  “rest,  rest.” 


How  anxiety  may  interfere 
In  a study  of  336  males  who  had 
suffered  at  least  one  myocardial 
infarction,  Sigler^  reports  that 
manual  workers  showed  the  lowest 
percentage  of  patients  returning  to 
work,  compared  to  clerical  workers, 
business  and  professional  men. 

The  author  notes  that  in  many 
cases  the  mere  apprehension  that 
“return  to  work  would  shorten  life 
prevents  the  patient  from  resuming 
activities.”  It  is  also  well  known 
that  emotional  disturbance  is 
probably  the  most  common  cause 
of  cardiac  disability  in 
postinfarction  cases. ^ 

The  anxiety  factor  in  both  coronary 
and  precoronary  patients  has 
recently  been  discussed  by 
Thomas,"  who  suggests;  “Intensive 
investigation  of  the  sources  and 
kinds  of  anxiety,  and  how 
destructive  forms  of  anxiety  can  be 
identified  and  relieved  may  be  the 
next  important  step  in  the 
prevention  of  coronary  heart 
disease.” 

Relief  of  anxiety  with  Librium® 
(chlordiazepoxide  HGl)  often 
proves  a valuable  adjunct  to 
medical  counsel,  reassurance  and 
the  total  management  program; 
may  help  prevent  the  postcoronary 
patient  from  regressing  into  a state 
of  invalidism. 

As  an  adjunct  in  cardiovascular 
therapy.  Librium® 
(chlordiazepoxide  HGl) : Quickly 
relieves  anxiety  of  mild  to  severe 
degree  in  most  cases.  Helps  expedite 
cooperation  in  therapeutic  regimen. 
May  be  used  concomitantly  with 
certain  specific  medications  of  other 
classes  of  drugs,  such  as  cardiac 
glycosides,  antihypertensive  agents 


and  diuretics.  By  relieving  anxiety, 
helps  encourage  productive 
activities.  Has  a wide  margin  of 
safety  and,  in  proper  maintenance 
dosage,  seldom  impairs  mental 
acuity  or  ability  to  function.  Often 
effective  in  extended  therapy, 
usually  without  diminution  of  effect 
or  need  for  increase  in  dosage- 
in  protracted  use,  periodic  blood 
counts  and  liver  function  tests  are 
advisable. 

References:  1.  Sigler,  L,  H.:  Geriatrics,  22:{9) 
97,  1967.  2.  Thomas,  C,  B.:  Johns  Hopkins 
Med.  ].,  722:69, 1968. 

Before  prescribing,  please  consult  complete 
product  information,  a summary  of  which 
follows: 

Indications:  Indicated  when  anxiety,  tension 
and  apprehension  are  significant 
components  of  the  clinical  profile. 
Contraindications:  Patients  with  known 
hypersensitivity  to  the  drug. 

Warnings:  Caution  patients  about  possible 
combined  effects  with  alcohol  and  other 
CNS  depressants.  As  with  all  CNS-acting 
drugs,  caution  patients  against  hazardous 
occupations  requiring  complete  mental 
alertness  (e.g.,  operating  machinery, 
driving).  Though  physical  and 
psychological  dependence  have  rarely  been 
reported  on  recommended  doses,  use 
caution  in  administering  to  addiction-prone 
individuals  or  those  who  might  increase 
dosage;  withdrawal  symptoms  (including 
convulsions),  following  discontinuation  of 
the  drug  and  similar  to  those  seen  with 
barbiturates,  have  been  reported.  Use  of 
any  drug  in  pregnancy,  lactation,  or  in 
women  of  childbearing  age  requires  that 
its  potential  benefits  be  weighed  against  its 
possible  hazards. 

Precautions : In  the  elderly  and  debilitated, 
and  in  children  over  six,  limit  to  smallest 
effective  dosage  (initially  10  mg  or  less 
per  day)  to  preclude  ataxia  or  oversedation, 
increasing  gradually  as  needed  and 
tolerated.  Not  recommended  in  children 
under  six.  Though  generally  not 
recommended,  if  combination  therapy 
with  other  psychotropics  seems  indicated, 
carefully  consider  individual  pharmacologic 
effects,  particularly  in  use  of  potentiating 


drugs  such  as  MAO  inhibitors  and 
phenothiazines.  Observe  usual  precautions 
in  presence  of  impaired  renal  or  hepatic 
function.  Paradoxical  reactions  («.g., 
excitement,  stimulation  and  acute  rage) 
have  been  reported  in  psychiatric  patients 
and  hyperactive  aggressive  chddren. 

Employ  usual  precautions  in  treatment  of  , 
anxiety  states  with  evidence  of  impending 
depression;  suicidal  tendencies  may  be 
present  and  protective  measures  necessary. 
Variable  effects  on  blood  coagulation  have 
been  reported  very  rarely  in  patients 
receiving  tbe  drug  and  oral  anticoagulants; 
causal  relationship  has  not  been  established 
clinically. 

Adverse  Reactions : Drowsiness,  ataxia  and 
confusion  may  occur,  especially  in  the 
elderly  and  debilitated.  These  are  reversible 
in  most  instances  by  proper  dosage 
adjustment,  but  are  also  occasionally 
observed  at  the  lower  dosage  ranges.  In  a 
few  instances  syncope  has  been  reported. 

Also  encountered  are  isolated  instances  of 
skin  eruptions,  edema,  minor  menstrual 
irregularities,  nausea  and  constipation, 
extrapyramidal  symptoms,  increased  and 
decreased  libido  — all  infrequent  and 
generally  controlled  with  dosage  reduction;  i 
changes  in  EEG  patterns  (low-voltage  I 

fast  activity)  may  appear  during  and  after  I 
treatment;  blood  dyscraslas  (including  \ 

agranulocytosis),  jaundice  and  hepatic  1 

dysfunction  have  been  reported  j 

occasionally,  making  periodic  blood  counts  j 
and  liver  function  tests  advisable  during 
protracted  therapy. 

To  curb  anxiety  ; 

in  the 

postcoronary  patient 
adjunctive 

Librium: 

(chlordiazepoxide  HCl) 

lO-mg  capsules 


Roche 

LABORATORIES 
Otvtsion  of  Hoffmann.  La  Roche  fnc. 
Nulfey.  New  Jersey  071  to 


Tlie 

President’s 

Page 


J.  Ernest  Breed 

Allocation  of  the  AM  A dues  dollar  . . . 


Last  June  the  House  of  Delegates  of  the 
AMA  approved  the  $40  increase  in  dues 
for  1971.  This  will  raise  the  dues  from  $70 
to  $110,  the  first  increase  since  1967.  No 
one  should  be  surprised  that  an  increase 
is  necessary  since  inflation  alone  at  about 
8%  a year  would  make  it  mandatory.  There 
are  many  reasons  of  which  you  may  not 
know.  The  major  reason  is  the  government 
tax  of  48%  on  “unrelated  income”  for  all 
not-for-profit  organizations,  such  as  medical 
societies  and  the  Boy  Scouts.  Ten  years  ago, 
50%  of  the  AMA  income  came  from  ad- 
vertising, and  43%  from  dues.  This  year 
39%  of  the  income  comes  from  dues  and 
34%  from  advertising  in  the  y\.MA  publi- 
cations. 

Two  years  ago,  the  House  of  Delegates 
approved  a statement  calling  for  intensi- 
fied leadership  by  the  AMA  in  medical 
problems  of  public  concern.  These  include 
all  kinds  of  problems,  such  as  ])hysician 
shortages,  national  health  insurance,  en- 
vironmental pollution,  nutrition  and  health 
care  delivery.  In  addition  to  the  problems 
of  public  interest,  it  has  been  necessary  to 
provide  new  services  to  the  profession  it- 


self, such  as  an  increase  in  medical  schools, 
continuing  education  for  doctors  in  prac- 
tice, professional  liability  insurance,  advice 
in  malpractice  claims,  accreditation  of  hos- 
pitals and  the  AMA  retirement  program, 
just  to  mention  a few. 

To  provide  all  these  services,  in  addition 
to  many  other  programs,  requires  new  per- 
sonnel. In  1967,  there  were  982  employees 
and  now  there  are  just  over  1,000,  but  the 
professional  help  has  increased  13%. 

This  year  the  operating  expenses  will  be 
over  $32  million,  which  includes  $25  mil- 
lion for  programs,  $1.5  million  for  office 
space  and  $6.7  million  for  administrative 
costs.  Inflation  alone  will  probably  add  an- 
other $2  million  a year  for  the  next  few 
years. 

Economies  have  been  installed,  including 
discontinuation  of  the  AMA  Research 
Foundation  and  holding  fewer  committee 
meetings  whenever  possible.  All  members, 
however,  realize  the  absolute  necessity  for 
a strong  AMA  to  guide  us  through  these 
trying  times  when  tremendous  changes  are 
being  made  in  the  world  of  medicine. 


University  of  Illinois  accepts  $500,000 
In  grants  at  the  Medical  Center 

The  University  of  Illinois  Medical  Center  Campus,  Chicago,  has  accepted 
an  overall  total  of  $542,349  in  research  and  training  grants  for  the  month 
of  September.  Out  of  17  grants  listed,  14  grants  totaling  $236,556  were 
from  the  United  States  Public  Health  Service. 

The  funds  were  allocated  as  follows:  $5,142,  College  of  Dentistry;  $236,- 
556,  College  of  Medicine;  and  $300,651,  Student  Affairs. 

The  largest  single  grant,  $139,814,  was  awarded  to  Dr.  Donald  A.  Boul- 
ton, dean  of  Student  Affairs,  by  the  United  States  Public  Health  Service  to 
be  used  for  the  Health  Professions  Scholarship  Program  in  Medicine. 


494 


Illinois  Medical  Journal 


volume  138,  number  5 novemher,  1970 

Encephalitis 

with 

Catatonic  schizophrenic 
symptoms 

By  Chang  Hwan  Kim,  M.D.,  and  Meyer  A.  Perlstein,  M.D.*/Chicago,  Illinois 

The  decision  to  give  anti-rabies  vaccine,  after  a bite  by  a stray 
animal,  should  be  carefully  considered  since  the  incidence  of  rabies 
in  all  untreated  bites  is  very  low  (less  than  1:50,000)  as  compared 
to  the  incidence  of  lethal  reactions  from  anti-rabies  vaccine.  The 
incidence  of  rabies  in  all  untreated  bites  varies  from  3 to  40  out 
of  an  estimated  2 million  animal  bites  per  year.^  Since  World  War 
II,  the  incidence  of  human  rabies  in  the  United  States  has  ranged 
from  a high  of  over  40  persons  per  year  to  a low  of  three. ^ In  the 
last  decade  only  one  or  two  human  cases  have  occurred  each  year.^ 

The  incidence  of  reaction  to  anti-rabies  vaccine,  on  the  other 
hand,  varies  from  1 in  146  persons^  to  1 in  8,287  persons.®  Some 
of  the  reactions  are  of  an  allergic  type  with  itching,  rashes  and 
general  signs  of  allergy.  Neuroparalytic  complications  occur  in 
1:287®  or  30  per  million  to  1 of  every  1,000  patients'^  given  treat- 
ment. 

When  paralytic  symptoms  occur,  the  mortality  may  be  20  to 
30%.*'®  When  the  symptoms  become  encephalitic  the  mortality 
rises  to  50%.^  Taking  the  highest  figure  for  the  incidence  of  rabies 
in  untreated  bites,  20  in  a million,  and  comparing  fatalities  for 
rabies  vaccine,  300  per  million,  the  chances  are  15:1  higher  that 
death  will  occur  from  the  vaccine  than  from  rabies.  Most  of  the 
reactions  that  have  occurred  have  been  reported  following  the  use 
of  anti-rabies  vaccine  giown  in  the  rabbit  brain  (Semple  vaccine). 

The  incidence  of  these  side  effects  has  been  lessened  by  the  use 
of  duck-embryo-grown  vaccine.  When  the  symptoms  of  anti-rabies 
vaccine  sequelae  are  paralytic  or  allergic,  the  diagnosis  is  relatively 
simple.  When  presenting  as  a psychiatric  syndrome,  it  may  be  con- 
fusing. Sobin  and  Ozer^®  reported  10  patients  with  acute  (non- 
vaccination) encephalitis  with  psychiatric  symptoms.  Two  of  them 
manifested  schizophrenic  catatonia.  The  differential  diagnosis  be- 
tween encephalitis  and  schizophrenia  was  extensively  documented 
by  Hollende  et  al.^^ 

We  have  seen  a case  in  which  the  clinical  picture  of  catatonic  schi- 
zophrenia following  Semple  anti-rabies  vaccine  therapy  developed. 


for  November,  1970 


505 


Case  history 

An  8-year-old  Negro  boy  was  admitted 
to  the  Children’s  Division  of  Cook  County 
Hospital  on  7/21/67.  About  3 weeks  be- 
fore admission  he  was  bitten  in  the  left 
leg  by  a stray  dog  in  the  playground  of  his 
house. 

The  dog  remained  undetected.  He  re- 
ceived 14  consecutive  daily  injections  of 
■Semple  anti-rabies  vaccine  at  the  Municipal 
Contagious  Disease  Hospital.  After  the 
eleventh  injection  he  became  listless  and 
agitated.  He  paced  back  and  forth,  raising 
and  dropping  his  hands.  Marked  person- 
ality changes  soon  became  evident;  he  be- 
came extraordinarily  talkative  and  hyper- 
active. On  July  19,  two  days  before  admis- 
sion and  five  days  after  the  fourteenth 
dose,  he  had  a generalized  convulsion,  fol- 
lowed by  low  grade  fever  and  vomiting.  His 
gait  became  ataxic  and  he  complained  of 
numbness  in  his  legs.  He  developed  visual 
hallucinations  (fire,  bubbles).  He  had  no 
difficulty  in  drinking  and  swallowing. 

On  admission,  he  was  non-ambulatory, 
mute  and  immobile.  He  was  well-nourished 
and  developed.  He  weighed  67  lbs.,  rec- 
tal temperature  99°F,  blood  pressure 
100/70  mm.  Hg.  He  was  withdrawn  and 
did  not  respond  to  verbal  commands. 
Occasionally  he  moved  slowly.  His  eyes  con- 
stantly stared,  neck  was  slightly  stiff,  ex- 
tremities were  held  stiffly,  pupils  were 
moderately  constricted  but  reacted  to  light, 
and  ocular  fundi  were  normal.  Deep  and 
superficial  reflexes  were  all  present  and 
normal  on  admission.  No  other  neurologi- 
cal abnormalities  were  noted.  Exteroceptive 
and  proprioceptive  sensory  function  could 
not  be  assessed  because  of  the  patient’s  se- 
vere withdrawl.  The  original  diagnosis  lay 
between  a modified  rabies  or  a post-vaccinal 
reaction. 

Laboratory  work  showed  a WBC  count 
of  8,600  per  cubic  mm.  with  normal  differ- 
ential, hemoglobin  of  12.5  Gm.  %,  blood 
urea  nitrogen  of  29  mg.  % and  normal 
electrolytes  for  sodium,  potassium,  chloride 
and  COo  combining  power.  Kahn  and  Was- 
serman  tests  were  negative.  Routine  uri- 
nalysis was  normal.  .Spinal  fluid  on  the  ad- 


Frorn  Children’s  Neurology  Service,  Cook  County 
Hospital,  and  Flektoen  Institute  for  Medical  Re- 
search, Chicago,  Illinois.  Supported  in  part  by 
Grant-CF-73-67C,  United  Cerebral  Palsy  Founda- 
tion. 


mission  and  the  twelfth  hospital  day  showed 
no  cells  but  slightly  increased  sugars  of  76 
and  92  mg.%  respectively.  Protein  and 
chloride  were  normal.  Culture  of  both 
spinal  fluid  and  blood  showed  no  organ- 
isms. No  pathology  was  seen  in  skull  and 
chest  X-rays.  Serum  antibody  to  rabies  vac- 
cine done  by  the  Public  Health  Service  in 
Atlanta,  Ga.  showed  positive  titer  in  dilu- 
tion of  less  than  1:50,  a positive  response 
to  vaccine,  against  21  MLD50,  indicating 
the  patient  was  protected  against  rabies. 

An  E.E.G.  on  the  fifth  hospital  day 
showed  a slow  wave  focus  in  the  left  parie- 
tal region  spreading  to  the  left  frontal  and 
occipital  areas  but  no  seizure  activity. 

By  the  second  week  of  hospitalization  the 
patient  was  so  severely  withdrawn  that  no 
response  could  be  obtained  to  verbal  com- 
mands or  visual  and  tactile  stimuli.  He 
continued  to  stare  at  the  ceiling  with  a “far- 
away-look.”  When  his  arm  or  leg  were 
raised,  they  retained  the  position.  A pro- 
visional diagnosis  of  Schizophrenia,  Cata- 
tonic type,  was  made  by  a consulting  child 
psychiatrist  at  this  time. 

During  the  following  five  days  the  pa- 
tient convulsed  frequently.  The  seizures 
lasted  for  about  five  to  eight  minutes,  start- 
ing in  the  left  arm  and  becoming  general. 
Another  E.E.G.,  a week  later,  showed  Grand 
Mai  seizure  activity  while  the  patient  con- 
tinued to  have  frequent  seizures. 

Treatment  with  corticosteroids  was  insti- 
tuted from  the  day  following  admission.  It 
was  started  with  Solu-medrol,  20  mg.  I.M., 
every  eight  hours,  for  two  weeks  and  switch- 
ed to  prednisone,  25  mg.  orally,  every  eight 
hours,  for  the  following  three  weeks  and 
tapering  off  over  the  next  two  weeks.  Pa- 
raldehyde, 5-7  ml.  rectally  and  phenobarbi- 
tal  sodium,  30  mg.  I.M.,  twice  a day,  were 
used  during  the  ensuing  days  for  control  of 
seizures.  Chloropromazine  was  stopped  af- 
ter only  three  days,  25  mg.  three  times  a 
day,  because  it  seemed  to  have  no  effect  on 
the  child’s  catatonic  condition. 

The  patient  began  to  improve  by  the 
third  week.  He  was  able  to  sit  in  a chair 
and  feed  himself.  At  this  time  he  walked 
with  a staggering  gait  and  had  intention 
tremors  in  the  arms.  He  responded  poorly 
to  the  commands  for  the  examination  of 
sensory  function.  However,  his  stiffness  be- 
came less  and  he  became  more  visually 
aware  of  his  environment.  E.E.G.  at  this 


504 


Illinois  Medical  Journal 


time  showed  marked  improvement  with  the 
subsidence  o£  seizure  activity.  He  was  less 
withdrawn  but  still  had  allalia  at  the  time 
of  discharge,  after  six  weeks  of  hospitaliza- 
tion. 

Discussion 

The  differential  diagnosis  on  admission 
was  between  an  atypical  rabies  due  to  the 
inadequate  effect  of  vaccine  therapy  and  a 
postvaccination  encephalopathy.  Since  the 
patient  developed  no  signs  of  rabies  such 
as  excitability  and  laryngeal  spasm  in  the 
ensuing  days,  that  diagnosis  was  eliminated. 

The  absence  of  signs  of  paralysis  in  the 
lower  extremities  and  bladder  or  bowel 
dysfunction  ruled  out  a primary  myelitic 
involvement.  The  diagnosis  of  encephalitis 
was  made  on  the  basis  of  the  history  of  on- 
set toward  the  end  of  rabies  vaccination 
and  presentation  with  fever,  seizure  and 
stiffness  of  neck  and  extremities.  The  out- 
standing symptoms  of  hallucination,  with- 
draw!, catatonia  and  mutism  were  sufficient 
for  the  diagnosis  of  catatonic  schizo- 
phrenia. Such  psychiatric  symptoms  are  not 
rare  in  organic  cerebral  diseases  but  are 
rare  in  post-vaccinal  encephalitis. 

The  marked  personality  changes  that  first 
occurred  in  this  case  were  not  primarily 
catatonic,  but  intense  irritability  and  list- 
lessness were  noted. 

Nichols,®  1946,  reported  two  cases  of  post- 
vaccinal encephalitis  due  to  rabies  vaccine 
whose  mentation  changes  were  initially  pre- 
ceded by  nervousness  and  irritability.  One 
patient  developed  a maniacal  mental  dis- 
order; much  crying,  excessive  laughing  and 
talking  but  no  catatonia. 

Various  psychiatric  symptoms  are  noted 
in  many  pathologic  conditions  of  the 
C.N.S.  Akinetic  mutism  was  first  described 
by  Cairns  et  ab-  in  a patient  with  an  epi- 
dermoid cyst  of  the  third  ventricle  and  pos- 
terior fossa  tumor,  especially  of  cerebellum. 
Other  causes  of  akinetic  mutism  are  brain 


stem  lesions  due  to  thrombosis  of  the  basi- 
lar artery,  tumors,  trauma,  viral  infections, 
cysts,  and  malaria. 

Catalepsy  in  animals  caused  by  bulbocap- 
nine  was  reported  as  far  back  as  1892.^® 

Psychiatric  changes  such  as  depression, 
premature  dementia,  and  neurasthenia  are 
reported  in  certain  neurocutaneous  diseases: 
Pseudoxanthoma  elasticum.  Keratosis  Fol- 
licularis  (Darier’s  Disease).^* 

Striking  psychiatric  changes  were  fre- 
cpient  in  epidemic  encephalitis  of  von  Econ- 
omo.’“'i®  They  have  not  been  observed  as 
frequently  in  other  types  of  encephalitis.-*^'23 
Minor  psychological  changes  such  as  im- 
paired concentration,  amnesia,  easy  forget- 
fullness,  confusion,  nightmares  and  noc- 
turnal emission  have  been  observed  in  the 
patients  treated  w'ith  Semple  anti-rabies  vac- 
cine,but  none  of  the  syndromes  were  seen 
in  our  patient. 

The  patient  reported  here  manifested  the 
classical  symptoms  of  catatonic  schizophre- 
nia: withdrawl,  non-responsiveness,  hallu- 
cination and  immobility  following  14  con- 
secutive treatments  of  Semple  rabies  vaccine 
made  of  rabbit  brain.  To  our  knowledge, 
this  form  of  a post-rabies  vaccinal  encepha- 
litis is  unique. 

It  was  possible  to  make  the  diagnosis  of 
encephalitis  as  the  underlying  process  in 
this  case  w'ith  the  presenting  objective 
neurological  findings  of  stiffness  of  neck 
and  extremities,  constriction  of  pupils, 
and  the  seizures  with  positive  electroen- 
cephalographic  change.  Hollander  et  aP^ 
discussed  the  problem  of  differential  diag- 
nosis of  encephalitis  and  psychiatric  symp- 
toms, particularly  of  the  catatonic  type  of 
schizophrenia. 

The  vaccine  given  in  this  case  is  Semple 
type  which  is  prepared  with  phenol-killed 
virus  grown  in  rabbit  brain.  Although  it 
induces  a higher  degree  of  antibody  syn- 
thesis“®"’  it  causes  more  neuroparalytic 
complication  than  duck-embryo  grown  vi- 


Chang  Hwan  Kim,  M.D.  (right),  is  a pediatric  neurology  con- 
sultant, Reed-Chicago  State  Hospital.  He  is  a graduate  of  the 
Yeun  Sei  Univ.  College  of  Medicine,  Seoul,  Korea,  and  served  his 
internship  in  Albany,  N.Y.,  and  a residency  at  Jefferson  Medical 
College  Hospital,  Philadelphia.  In  addition  he  has  done  fellow- 
ship work  in  pediatric  neurology  under  the  United  Cerebral 
Palsy  Foundation  at  Cook  County  Hospital.  M.  A.  Perlstein,  M.D. 
(left),  was  professor  of  pediatries  at  Northwestern  Medical 
School  and  head  of  Pediatric  Neurology  at  Cook  County  Hos- 
pital. Dr.  Perlstein  died  recently  in  California. 


for  November,  1970 


505 


rus.  The  frequency  of  severe  encephalitis 
due  to  this  vaccine  varies  from  1:1,000  to 
1:4,000  persons  given  treatment.®--®'3o  The 
mortality  of  encephalitis  due  to  this  vac- 
cine varies  from  30%^  to  50%4  Survi- 
vors usually  manifest  few  permanent  se- 
quelae.^^ 

The  most  common  neurological  compli- 
cations of  rabies  vaccination  are: 

1.  Peripheral  neuritis,  especially  facial, 
usually  ending  in  complete  recovery. 

2.  Lumbar  myelitis  with  low  mortality 
rate. 

3.  Encephalomyelitis  with  Landry’s  as- 
cending paralysis  with  a high  mortality 
rate  due  to  bulbar  paralysis.®  -'*’^- 

The  autopsy  findings  mainly  show  focal 
demyelinating  process  with  associated  peri- 
vascular inflammation.  The  evidence  of 
neurological  complication  usually  develops 
from  the  fourth  to  fourteenth  day  of  in- 
jection. However,  Ford®®  reported  a case 
which  occurred  four  months  after  vaccina- 
tion. In  general,  more  severe  cases  appear 
earlier  than  milder  ones. 

W.H.O.  Expert  Committee  on  Rabies 
recommends  the  switch  from  Semple  to 
avian-embryo  vaccine  when  premonitory 
symptoms  indicating  neuroparalytic  com- 
plications develop.®^"®®  A comparison  was 
made  of  the  general  and  local  reactions 
duck-embryo  rabies  vaccine  and  Semple 
brain-tissue  rabies  vaccine  in  123  patients 
by  Greenberg  and  Childress®^  in  1960.  In 
their  study,  the  complication  of  encepha- 
lomyelitis did  not  occur  in  two  patients 
who  received  the  vaccine  containing  brain 
tissue.  Neuroparalytic  complications  occur- 
red in  44  patients  treated  with  brain  tissue 
rabies  vaccine  in  the  anti-rabies  clinics  of 
the  New  York  City  Department  of  Health 
from  1828,  to  1951. 3® 

Clinical  effect  and  the  experiences  in 
human  use  of  the  duck-embryo  vaccine  have 
been  studied. ®®‘^3 

Sharp  and  McDonald  (Britain,  1967)®^ 
recently  reported  20  cases  showing  various 
reactions  following  the  Semple  rabbit-brain 
vaccine.  The  two  of  these  20  patients  were 
severely  ill  and  many  of  them  suffered  from 
various  mental  symptoms.  None  of  them 
showed  schizophrenic  reaction. 

The  patient  in  the  present  report  has 
recovered  with  the  alleviation  of  neurologic 
signs  and  schizophrenic  symptoms  after 
five  weeks  of  treatment  with  corticosteroids. 


Although  the  phenothiazines  are  known  to 
be  effective  in  the  treatment  of  schizo- 
phrenia (catatonic  and  paranoid  type),'*^ 
chloropromazine,  which  was  given  to  this 
patient,  was  discontinued  after  three  days 
trial  because  it  seemed  to  enhance  the  cata- 
tonic condition.  Actually  the  catatonic  con- 
dition may  have  been  a form  of  extrapyra- 
midal  rigidity  due  to  involvement  of  basal 
nuclei  by  the  encephalitic  reaction  and  thus 
may  have  been  aggravated  by  the  thorazine. 

Briggs  and  Brown®  reported  a case  which 
showed  dramatic  response  to  the  treatment 
with  corticosteroids  which  developed  the 
signs  of  a profound  degree  of  encephalo- 
myelitis. Their  patient  did  not  present  any 
mental  symptoms.  They  treated  the  patient 
with  100  mg.  of  hydrocortisone,  I.V.,  which 
was  followed  by  25  mg.  of  prednisolone 
orally  four  times  a day.  Blatt  and  Lepper^ 
reported  three  patients  treated  with 
A.C.T.H.;  two  of  whom  also  showed  dra- 
matic response. 

This  report  emphasizes  the  danger  of  the 
everlasting,  undesired  adverse  reaction  to 
anti-rabies  vaccine,  especially  of  the  prep- 
aration of  brain  tissue,  which  often  causes 
not  only  fatal  neuroparalytic  complications 
but  also  severe  psychiatric  change. 

Summary 

LA  patient  with  an  unusual  clinical  re- 
action to  the  Semple  antirabies  vaccine 
is  reported. 

2.  The  picture  was  that  of  Catatonic 
Schizophrenia  with  underlying  en- 
cephalitis. The  patient  gradually  im- 
proved on  corticosteroids. 

References 

1.  Daniel,  L.  D..  “Rabies  Prevention— A Practical 
Guide,”  Mo.  Med.,  62.;367-71,  May,  1965. 

2.  Hildreth,  E.  A.,  “Prevention  of  Rabies,”  Ann. 
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3.  Editorial:  “Treatment  of  Persons  Exposed  to 
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4.  Blatt,  N.  H.,  and  Lapper,  M.  H.,  “Reaction 
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6.  Briggs,  G.  D.,  Brown,  W.  M.,  “Neurological 
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23.  Weinstein,  E.  A.,  Idnn,  L.,  and  Kahn,  R.  L., 
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24.  Sharp,  J.  C.  M.,  and  McDonald,  S..  “Effects  of 
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July,  1967. 

25.  Gibbs,  F.  A.,  Gibbs,  E.  L.,  Carpaenter,  P.  R., 
and  Spies,  H.  W.,  “Comparison  of  Rabies  Vac- 
cines Rrown  on  duck  embryo  and  on  nervous 
tissue,”  New  Eng.  J.  Med.,  265:1002,  1961. 

26.  Greenberg,  M.,  and  Childress,  J.,  “Vaccination 
asrainst  rabies  with  duck  embryo  and  Semple 
Vaccine,”  JAMA,  173:33,  1960. 


27.  Dean,  D.  J.,  and  Sherman,  L,  “Potency  of  Com. 
mercial  Rabies  Vaccine  used  in  Man,”  Pith. 
Health  Rep.,  77:705,  1962. 

28.  Johnson,  H.  N.,  Rabies,  in  Viral  and  Rick- 
ettsial Infections  of  Man.  P.  405,  3rd.  Ed., 
Edited  by  Rivers,  T.  M.,  and  Horsfall,  F.  L., 
J.  B.  Lippincott  Co.,  Philadelphia,  1959. 

29.  Pait,  C.  F.,  and  Pearson,  H.  E.,  “Rabies  (Sem- 
ple) Vaccine  Encephalomyelitis  in  relation  to 
the  Incidence  of  Animal  Rabies  in  Los  An- 
geles,” Amer.  ].  Pub.  Health,  39:875,  1949. 

30.  Briggs,  G.  W.,  and  Brown,  W.,  “Neurological 
Complications  of  Anti-Rabies  Vaccine,”  JAMA, 
173:802,  1960. 

31.  Mckendrick,  A.  C.:  ninth  analytical  review 

of  reports  from  Pasteur  Institute  on  the  results 
of  anti-rabies  treatment,”  Bull.  World  Health 
Organ.,  9:31,  1940. 

32.  Redwill,  F.  H.,  and  Underwood,  L.  J.,  “Neuro- 
logical Complications  to  Treatment  with  Rabies 
Vaccine,”  Calif.  Med.,  66:360-63,  1947. 

33.  Ford:  Diseases  of  The  Nervous  System  in  In- 
Fancy,  Childhood,  and  Adolescence.  P.  578, 
5th.  Ed.,  Charles  C.  Thomas. 

34.  “Expert  Committee  on  Rabies:  World  Health 
Organization  Technical  Report  on  Rabies,”  No. 
201,  Geneva,  World  Health  Organization,  1960. 

35.  “Expert  Committee  on  Rabies:  World  Health 
Organization  Technical  Report,”  Ser.,  121,  1957. 

36.  Fox,  J.  P.,  “Prophylaxis  Against  Rabies  in 
Humans,”  Ann.  New  York  Acad.  Sc.,  70:480-94, 
1958. 

37.  Greenberg,  M.,  and  Childress,  J.,  “Vaccination 
Against  Rabies  with  Duck-Embryo  and  Semple 
Vaccine,”  JAMA,  173:333-37,  1960. 

38.  Applebaum,  E.,  Greenberg,  M.,  and  Nelson,  J., 
“Neurological  Complication  Following  Anti- 
Rabies  Vaccination,”  JAMA,  151:188-91,  1953. 

39.  Schwab,  M.  P.,  Fox,  J.  P.,  Conwell,  D.  P.,  and 
Robinson,  T.  A.,  “Avianized  Rabies  Virus  Vac- 
cination in  Man,”  Bull.  World  Health  Org., 
10:823,  1954. 

40.  Fox,  J.  P.,  Conwell,  D.  P.,  and  Gerhardt,  P., 
“.Anti-rabies  vaccination  of  man  with  HEP 
Flurry  virus,”  Bull.  Tulane  Univ.  Med.  Fac., 
16:1,  1956. 

41.  Fox,  J,  P.,  Koprowski,  H.,  Conwell,  P.  P., 
Black,  J.,  and  Gelfand,  H.  M.,  “Study  of  anti- 
rabies immunization  of  man.  Observations  with 
HEP  Flurry  vaccine  and  other  vaccines  and 
with  hyperimmune  serum  in  primary  and  re- 
call immunizations,”  Bull.  World  Health  Or- 
ganization, In  Press,  1957. 

42.  Peck,  F.  B.,  Powell,  H.  M.  Jr.,  and  Culbertson. 
C.  G.,  “New  anti-rabies  vaccine  for  human  use,” 
J.  Lab.  Clin.  Med.,  45:679,  1955. 

43.  Peck,  F.  B.,  Powell,  H.  M.  Jr.,  and  Culbertson, 
C.  G.,  “Duck-embryo  rabies  vaccine.  Study  of 
fixed  virus  vaccine  grown  in  embryonated  duck 
eggs  and  killed  beta-propiolactone  (BPL)  ,” 
lAMA,  162:1373,  1956. 

44.  Chapman,  Textbook  of  Clinical  Psychiatry. 
P.  239,  Lippincott. 


Women  Are  Wage  Earners  for  One-fifth  of  Households 

When  mother  is  the  bread  winner,  the  bread  is  sliced  thinner,  a recent 
survey  reported  by  the  National  Consumer  Finance  Association  reveals. 
Women  are  now  wage  earners  for  20%  of  all  U.S.  households,  and  earn 
an  average  of  nearly  $5,000  a year  less  than  male  counterparts.  Their 
average  yearly  income  is  $4,278,  as  compared  to  $9,195  for  households 
headed  by  males. 


for  November,  1970 


507 


THE  VIEW  BOX 


By  Leon  Love,  M.D. 

Director,  Department  of  Radiology,  Loyola  University  Hospital 
and  Chairman,  Department  of  Radiology,  Loyola  University 
Stritch  School  of  Medicine 


This  50-year-old  male  patient  entered  the  hospital  com- 
jilaining  of  acute  difficulty  in  swallowing  and  noted  that  he 
had  been  fine  until  he  had  eaten  a steak  about  twelve  hours 
previously.  At  the  time  of  admission,  there  was  continued 
regurgitation  and  the  patient  was  in  acute  distress.  The 
physical  examination  was  otherwise  unremarkable.  What’s 
your  diagnosis? 

1.  Carcinoma  of  the  distal  esophagus 

2.  Peptic  esophagitis 

3.  Steak  eaters  disease 

4.  Sarcoma  of  the  distal  esophagus 

(Answer  on  page  558) 


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Illinois  Medical  Journal 


Surgicol  Grajid  Rounds  are  held  weekly  on  Saturday  at 
8:00  a.ni.  in  the  Offield  Auditorium  at  Passavant  Memorial 
Hospital.  Patient  presentations  from  Chicago  Wesley  Me- 
morial, Passavant  Memorial,  and  the  Veterans  Administra- 
tion Research  Hospitals  for?n  the  basis  of  the  discussions. 
This  case  report  was  part  of  the  Surgical  Grand  Rounds 
held  on  January  24,  1970. 


Acoustic  neuroma 


Edited  by  John  M.  Beal,  M.D. 


Case  Report: 

Dr.  Bernard  Feldman:  A 58-year-oId  white 
female  was  admitted  to  Passavant  Me- 
morial Hospital  January  5,  1970  with  a 
chief  complaint  of  a roaring,  humming 
noise  in  her  left  ear  for  the  past  two  years. 
Approximately  two  years  before  admission, 
she  noticed  the  gradual  onset  of  tinnitus, 
associated  with  gradual  but  progressive 
hearing  loss  in  the  left  ear.  Several  months 
prior  to  admission,  she  noted  the  onset  of 
numbness  and  tingling  on  the  left  side  of 
her  mouth  and  a burning  sensation  on  the 
end  of  her  tongue.  She  denied  any  un- 
steadiness of  gait,  dizziness,  or  visual  dis- 
turbances. A few  weeks  before  admission, 
she  noted  the  onset  of  a pressure  sensation 
over  her  occipital  area  and  the  back  of  her 
neck. 

Pertinent  physical  findings  at  the  time 
of  admission  were  limited  to  the  neurologi- 
cal examination  as  follows:  her  left  palpe- 
bral fissure  was  slightly  wider  than  the  right. 
On  rapid  lid  fluttering,  the  left  lid  did  not 
close  as  well  as  the  right.  There  was  slight 
left  lower  facial  asymmetry  on  grimacing. 
Pain  to  pin  prick  and  light  touch  was  di- 
minished over  the  entire  left  side  of  the 
face.  There  was  diminished  taste  sensation 
to  salt  and  sugar  on  the  anterior  two-thirds 
of  the  tongue  on  the  left.  She  had  decreased 
ability  to  hear  in  her  left  ear.  Although 


lateralization  of  the  Weber  test  was  absent, 
bone  conduction  was  greater  than  air  con- 
duction in  the  left  ear. 

On  January  13,  she  was  taken  to  the 
operating  room,  where  a posterior  fossa 
craniotomy  and  total  resection  of  her  acous- 
tic neuroma  was  performed  by  Drs.  Rai- 
mondi and  Kerth. 

Immediately  alter  surgery,  she  was  alert 
and  oriented,  able  to  talk  and  responded 
quite  well.  The  only  abnormality  initially 
was  a left  facial  paresis.  On  the  first  post- 
operative day,  she  became  progressively 
more  obtunded  and  there  was  facial  and  per- 
iorbital edema.  By  the  evening  of  the  first 
postoperative  day,  she  was  quite  obtunded 
and  responded  only  to  painful  stimuli.  A 
tracheostomy  was  performed  in  order  to 
suction  her  secretions  and  to  provide  bet- 
ter aeration.  On  the  second  postoperative 
day,  she  was  slightly  better;  however,  on 
the  third  day,  she  showed  dramatic  im- 
provement, became  alert  again,  and  was 
able  to  speak.  She  is  now  well  recovered. 
Dr.  Joseph  C.  Sherrick:  The  specimen 
consisted  of  multiple  fragments  of  yellow 
and  light  tan  tumor,  the  largest  measuring 
2 cm.  in  maximum  dimension.  Microscopi- 
cally the  tumor  consisted  of  spindle-shaped 
cells  with  their  nuclei  aligned  in  rows,  the 
so-called  palisading  of  nuclei.  Parts  of  the 


5!0 


Illinois  Medical  Journal 


Fig.  1.  Microscopic  examination  of  the  acoustic  neu- 
roma shows  spindle-shaped  cells  with  palisading  of 
nuclei. 


tumor  were  solidly  cellular,  Antoni  Type 
A tissue,  seen  on  the  left  side  of  Figure  1. 
Other  areas  are  more  loosely  arranged  and 
cystic,  as  seen  in  the  upper  right  of  Figure 
1,  and  known  as  Antoni  Type  B tissue. 
These  tumors  are  derived  from  nerve 
sheath  cells  and  are  called  neurilemomas. 
They  may  occasionally  contain  intermingl- 
ctl  nerve  fibers,  which  has  led  to  the  use 
of  the  term  acoustic  neuroma. 

The  portion  of  cerebellum  we  received 
showed  no  significant  abnormality. 

Dr.  Jack  Kerth:  This  patient  demon- 
strates very  typically  the  history  and  pro- 
gression of  an  acoustic  neuroma.  First,  she 
is  a female.  Acoustic  neuromas  occur  about 
twice  as  often  in  females  as  they  do  in 
males.  Second,  her  initial  complaint  and 
actually  the  only  significant  complaint 
throughout  the  year  and  a half  that  I fol- 
lowed her  was  a hearing  loss  on  the  left 
side.  She  had  unilateral  hearing  loss  only, 
without  other  symptoms,  or  other  com- 
plaints. Her  hearing  loss  was  a pure  sen- 
•sorineural  type  without  indication  of  the 
etiology.  A number  of  audiometric  tests  are 
performed  when  we  see  a patient  with  a 
unilateral  hearing  loss.  The  main  three 
tests  in  this  battery  are:  (1)  a test  of 

the  hearing  level  at  500,  1,000,  2,000  and 
4,000  frequencies;  (2)  a determination  of 
the  patient’s  ability  to  understand  spoken 
words  such  as  yard,  carve,  ran,  etc  This  is 
a somewhat  more  complex  task  for  the 
hearing  apparatus  than  the  frequency  test. 
When  I first  saw  this  lady,  this  test  was 
essentially  normal.  The  other  important 
test  performed  in  patients  in  whom  we 
suspect  an  acoustic  neuroma,  and  anyone 


who  presents  with  a sensorineural  loss  uni- 
laterally as  a candidate  for  a neuroma,  is 
the  tone  decay  test.  A pure  tone,  at  500, 
1,000,  and  2,000  frequencies  is  presented  to 
the  questionable  ear  and  one  determines 
how  long  the  patient  can  hear  this  tone  at 
the  level  presented.  If  there  is  tone  decay, 
typically  found  in  patients  with  a retro- 
cochlear  lesion,  which  an  acoustic  neuroma 
is,  then  the  patient  does  not  hear  the  tone 
for  a standard  period  of  time.  Typically, 
one  presents  the  stimulus  at  15  decibels 
above  threshhold;  it  will  be  heard  for  5 
seconds  and  then  disappear.  In  spite  of  in- 
creasing the  intensity  of  the  stimulus,  it 
repeatedly  fades  in  the  ear  of  the  patient. 
Thus  the  name,  tone  decay  test.  The  nor- 
mal person  will  hear  this  tone  at  the 
initial  intensity  for  about  60  seconds.  When 
first  seen,  this  patient  had  only  a unilateral 
sensorineural  hearing  loss  without  poor 
sneech  discrimination  and  without  the  tone 
decay.  Other  sophisticated  audiometric  tests 
may  be  performed,  but  they  are  not  im- 
portant for  our  discussion. 

There  are  only  about  three  other  causes 
for  unilateral  hearing  loss  besides  acoustic 
neuroma.  One  is  Meniere’s  disease,  or 
swelling  of  the  endolymphatic  system  in 
the  inner  ear;  another  is  cochlear  otoscle- 
rosis—an  abnormal  growth  of  bone  in  the 
capsule  of  the  inner  ear.  Then  there  is  a 
relatively  large  category  about  which  we 
know  very  little,  and  this  is  etiology  un- 
determined. 

At  the  time  I first  saw  this  patient,  she 
did  not  fall  into  any  known  category.  The 
only  other  test  that  we  did  originally  was 
a caloric  test.  This  was  normal.  Routine 
skull  and  mastoid  X-rays  at  that  time  were 
not  taken  because  of  the  relatively  normal 
hearing  and  caloric  tests.  Most  people- 
over  80%— who  present  with  an  acoustic 
neuroma  will  have  a diminished  caloric 
response.  Because  unilateral  hearing  loss 
may  be  secondary  to  an  acoustic  neuroma 
and  that’s  one  of  the  somewhat  rare  con- 
ditions that  we  can  treat  well  when  found 
early,  we  follow  patients  with  unilateral 
hearing  loss  very  closely.  I was  unable  to 
follow  this  lady  as  closely  as  I would  have 
liked;  she  came  back,  not  at  six  months 
as  she  should  have,  but  at  nine  months,  and 
then  she  waited  even  longer  before  she 
would  consent  to  continue  with  our  diag- 
nostic work-up. 


for  November,  1970 


51] 


In  this  interval  of  nine  months,  her  symp- 
toms did  not  really  change.  She  noticed  a 
slight  progression  in  hearing  loss,  but  that 
was  about  all.  She  did,  however,  show  a 
dramatic  change  in  her  hearing  tests.  She 
had  increased  sensorineural  loss.  Her  dis- 
crimination, which  was  around  96%  ini- 
tially, dropped  down  to  about  50%.  She 
now  had  tone  decay  and  a diminished 
caloric  on  the  left  side.  Thus,  I was  very 
suspicious  of  an  acoustic  neuroma  and  sent 
her  for  X-rays. 

There  are  a number  of  types  of  X-rays 
that  one  can  order  for  patients  such  as  this 
lady.  The  routine  skull  X-rays  taken  at 
the  routine  hospital  by  the  routine  X-ray 
department  frequently  do  not  show  an 
acoustic  neuroma  of  small  to  medium  size. 
Ihey’ll  show  large  ones  with  significant 


doing  the  test  is  familiar  with  the  pro- 
cedure, then  there  is  something  occluding 
the  canal.  It  mav  be  a neuroma,  a mening- 
ioma, some  type  of  cyst,  or  it  may  be  ad- 
hesions from  an  old  arachnoiditis;  there 
is  some  abnormality  there. 

In  the  patient  presented  today,  the  con- 
trast agent  did  not  fill  the  internal  audi- 
tory canal  and  there  actually  was  a rounded 
mass  protruding  from  the  canal  (Figure  2). 
Although  the  obstruction  of  the  internal 
auditory  canal  did  not  have  to  be  a neu- 
roma, 80  to  90%  of  the  tumors  or  obstruc- 
tions in  this  region  are  acoustic  neuromas. 

Presentation  of  the  patient 

The  patient  was  10  days  postoperative. 
A left-sided  facial  paralysis  was  demon- 
strated. (At  the  termination  of  the  opera- 


V 


cisterna 

site  of  tumor 


auditory 
canal 


Fig.  2.  The  posterior  fossa  myelogram  demonstrates  the  mass  protruding  from  the  internal  audi- 
tory canal. 


erosion  of  the  internal  auditory  canal,  but 
not  a small  to  moderate  sized  neuroma. 
Laminograms  are  an  improvement,  but 
there  are  X-rays  which  are  somewhat  more 
sophisticated  than  the  laminograms.  These 
are  called  polytomograms.  They  are  taken 
with  a very  specialized  type  of  machine. 
The  ultimate  diagnostic  tool  and  one  step 
more  sophisticated  than  the  polytomograms 
is  a posterior  fossa  myelogram  combined 
with  polytomography.  This  is  performed  by 
injecting  1-2  cc.  of  a radiopaque  dye  into 
the  subarachnoid  space,  tilting  the  patient’s 
head  down,  and  visualizing  the  posterior 
fossa.  The  main  objective  in  this  study  is 
the  outlining  of  the  internal  auditory 
canal  with  the  dye.  In  experienced  hands, 
practically  100%  of  the  time  this  can  be 
done.  If  the  dye  will  not  run  into  the 
internal  auditory  canal  and  if  the  person 


tion,  just  prior  to  closure,  the  facial  nerve 
had  been  stimulated  and  good  facial  move- 
ment resulted.  Facial  function  can  be  anti- 
cipated within  the  next  six  months.)  The 
patient  walked  in  tandem  and  had  moder- 
ate difficulty  with  this.  (Patient  leaves.) 

Dr.  Anthony  Raimondi:  This  patient 

shows  how  far  we  have  come  in  the  man- 
agement of  this  kind  of  tumor.  In  the  time 
of  Harvey  Cushing,  this  tumor  was  con- 
sidered inoperable.  This  held  true  until  the 
early  1940’s,  with  the  exception  of  Dandy, 
who  had  published  something  like  50  or 
60  cases  with  a 5-10%  mortality,  and  then 
went  on  to  do  well  over  400  or  500,  main- 
taining roughly  the  same  mortality.  The 
morbidity  which  he  encountered  was,  how- 
ever, what  we  today  would  consider  pro- 
hibitive. He  automatically  accepted  a VII 
paralysis:  he  accepted  a V paralysis;  the 


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Illinois  Medical  Journal 


VIII  was  inevitable,  as  it  is  at  this  time; 
he  would  accept,  gladly,  a paralysis  of  IX, 
X,  XI  and  XII,  plus  a hemiplegia.  It  was 
standard  operating  procedure  to  do  a tar- 
sorrhaphy postoperatively  because  the  pa- 
tients were  considered  to  have  at  least  a 
V nerve  palsy,  lest  they  suffer  corneal  ul- 
cerations. 

Then,  with  the  advent  of  three  things, 
we  have  come  to  the  present  time.  One  is 
the  ability  of  the  otologists  to  make  a pre- 
sumptive diagnosis  of  an  acoustic  neuroma 
in  something  like  95%  of  the  patients.  The 
second  is  the  ability  of  the  radiologist, 
using  poly  tomography  and  pantopaque  cis- 
ternography, to  confirm  the  diagnosis  in 
almost  100%  of  the  patients,  and  beyond 
that,  to  give  a clear  idea  as  to  the  size  and 
extent  of  the  tumor.  This  permits  the  sur- 
geon to  plan  his  flap  and  the  degree  of 
surgery  (at  least  the  destructive  element  of 
the  surgery)  in  a much  more  meaningful 
way.  The  third  thing  is  the  advent,  again 
from  the  otologist,  of  the  operating  micro- 
scope, so  that  this  tumor  may  be  dealt  with 
in  a microscopic  fashion,  consequently  as- 
sisting us  in  avoiding  the  anterior  inferior 
cerebellar  artery,  which  is  really  what 
causes  many  postoperative  deaths.  We  once 
occluded  the  anterior  inferior  cerebellar  ar- 
tery unknowingly,  thus  giving  the  patient 
an  infarct  of  the  pons.  That  night  the 
patient  would  develop  a clinical  picture 
which  looked  like  shock,  but,  in  essence, 
really  signified  that  the  pons  infarcted.  The 
microscope  gives  us  the  opportunity  to  save 
the  VII  cranial  nerve  in  these  patients,  so 
that  they  do  not  have  permanent  deformity, 
necessitating  a nerve  graft  and  then  requir- 
ing the  patient  to  learn  to  lift  the  shoulder 
or  move  the  tongue  in  order  to  get  move- 
ment on  that  side  of  the  face. 

With  the  collaboration  between  otologists 
and  neurosurgeons,  the  last  phase  was  the 
development  of  a surgical  technique  which 
would  make  this  type  of  surgery  meaning- 
ful and  available  to  more  institutions. 

Here,  really,  what  we  did  was  just  a 
standard  posterior  fossa  opening.  The  tum- 
or was  considerably  larger  than  the  radiol- 
ogist had  predicted,  but  it  was  still  at  least 
not  so  large  that  we  couldn’t  deal  with  it 
effectively.  After  I took  oft  the  lateral  third 
of  the  cerebellum,  electively,  in  order  to 
have  good  exposure  and  in  order  not  to 
retract  on  the  brain  stem.  Dr.  Kerth  opened 


the  petrous  pyramid.  He  opened  the  medial 
third  of  it  and  thus  allowed  for  the  identi- 
fication of  tumor.  He  pointed  out  the  VII 
nerve  to  me,  and  then  I took  over  the  dis- 
section, lifting  the  tumor  off  the  VII  nerve 
and  carrying  the  disection  medially,  with 
Dr.  Kerth  coming  in  from  time  to  time  to 
look  again  at  the  VII  nerve  out  distally 
in  the  petrous  pyramid  and  then  medially 
coming  off  of  the  pons.  In  this  manner  we 
were  able,  by  using  the  operating  micro- 
scope and  by  working  in  tandem,  to  take 
what  amounted  to  a plum-sized  tumor  out 
of  the  angle,  off  of  the  pons,  and  away  from 
the  VII  cranial  nerve,  saving  this  nerve 
entirely.  At  the  end  of  surgery,  stimulating 
the  VII  cranial  nerve  at  its  exit  from  the 
pons,  we  got  a full  giimace  on  the  left  side. 
This  paresis,  rather  than  palsy,  that  she  has 
of  her  VII  nerve  now,  is  certainly  transient. 
She  already  has  some  “pucker”  and  some 
“flicker”  of  movement  on  the  left  side,  and 
she  most  probably  will  have  quite  good 
facial  movement  postoperatively. 

Dr.  John  Beal:  Why  do  you  take  off  part 
of  the  cerebellum?  Does  it  leave  any  defect? 
Dr.  Raimondi:  The  lateral  third  of  the 
cerebellum  leaves  no  permanent  defect. 
Postoperatively,  she  had  nystagmus  of  a 
curious  kind,  in  that  the  rapid  component 
of  the  nystagmus  was  to  the  inappropriate 
side.  Dr.  Drachman  got  very  excited  about 
this.  It  has  since  cleared,  as  has  her  nystag- 
mus. She’ll  recover  totally  from  any  evi- 
dence that  we  would  attribute  to  the  lateral 
third  of  the  cerebellum.  Her  difficulty  now, 
I think,  is  still  pontine  and  not  cerebellar. 
One  does  very  well  without  the  lateral  third 
of  the  cerebellum.  The  reason  for  taking 
it  off  is  to  have  adequate  exposure.  With 
inadequate  exposure,  one  ends  up  retract- 
ing, and,  if  you  retract  on  the  brain  stem, 
you  get  swelling  and  then  lose  the  patient. 
In  order  to  get  the  tumor  out,  one  takes 
what,  really,  the  patient  can  do  very  well 
without. 

Dr.  Beal:  Do  you  remove  the  entire  tumor 
or  part  of  it? 

Dr.  Raimondi:  Without  the  operating 
microscope,  this  most  certainly  would  have 
been  considered,  by  me— a total  resection. 
With  the  operating  microscope.  I’d  have  to 
estimate  that  we  left  somewhere  between 
an  eighth  and  a quarter  of  a gram.  There 
is  no  tumor  left,  as  I would  consider  tumor, 

(Continued  on  page  560) 


for  November,  1970 


513 


The  wound 
that  killed 
Lincoln 


By  John  K.  Lattimer,  M.D./New  York 


Chronology  of  the  hours  after  the  shooting 


Time  (Close 
10:13  p.m. 


10:20 

10:30 

10:50 


10:55 

11:00 

11:30 


1:00  a.ni. 


1:30 

2:00 


2:32 

5:30 


7:21  & 

55  sec. 

7:22  & 

10  sec. 
12:10  p.m. 


approximations) 

Lincoln  shot 

Clot  on  left  shoulder  but  very  little  ooze  from 
wound  at  first. 

Wound  probed  by  finger  of  Dr.  Leale  to  depth 
of  two  inches. 

Moved  to  house  across  the  street  from  theatre — 
clots  evacuated  repeatedly  to  relieve  breathing. 
Brandy  apparently  swallowed— one  pupil  con- 
tracted— one  pupil  dilated;  both  unresponsive  to 
light. 

Pulse  48 

Brandy  not  swallowed — left  eyelid  echymosed — 
pulse  42  and  weaker. 

Right  eye  socket  filled  with  blood  with  great  pro- 
trusion of  eye — pulse  45. 

Twitching  of  face  on  left  for  20  minutes;  mouth 
drawn  slightly  to  left. 

Spasmodic  contractions  of  muscles,  pronation  of 
both  forearms — both  pupils  became  widely  dilated 
— stayed  so  until  death — breath  held  during  spasms 
— pulse  to  100. 

Pulse  95 

Silver  probe  passed  by  Dr.  Barnes — hit  plug  of 
skull  at  three  inches  (verified  at  autopsy)  too 
short  to  follow  whole  length  of  track.  Nelaton 
probe  in  5 inches  and  struck  the  left  orbital  plate. 
(Taft) 

Pulse  54 

Oozing  of  fluid,  blood  and  brain  tissue  ceased — 
breathing  stertorous — pulse  64  and  thready — res- 
pirations 27. 

Breathing  ceased. 

Pulse  inperceptible. 

Autopsy  performed  at  the  White  House  in  Lincoln’s 
bedroom. 


514 


Illinois  Medical  Journal 


One  hundred  and  five  years  ago.  Presi- 
dent Lincoln  was  sitting  in  a rocking  chair 
in  a box  at  Ford’s  Theatre  in  Washington, 
watching  a play  on  Good  Friday  evening. 

If  General  Grant  had  accompanied 
President  Lincoln  to  Ford’s  theatre  on  the 
night  of  April  14,  1865,  President  Lincoln 
would  not  have  been  shot.  General  Grant’s 
large  military  bodyguard  was  specifically 
instructed  in  the  matter  of  preventing  assas- 
sins from  approaching  their  Commander, 
and  it  is  doubtful  that  Booth  could  have 
gotton  close  to  either  man.  Unfortunately, 
Mrs.  Grant  did  not  like  Mrs.  Lincoln,  and 
persuaded  the  General  to  renege  on  his 
acceptance  of  the  invitation,  even  though 
it  had  been  announced  in  the  newspapers 
early  in  the  day.  Washington  was  still  cele- 
brating Lee’s  surrender,  five  days  earlier,  at 
Appomatox,  and  Grant  was  the  conquer- 
ing hero.  Everyone  was  delighted  that  he 
might  appear  at  the  theatre  with  the  Lin- 
colns that  eveningi-2  and  people  flocked  to 
buy  tickets. 

At  about  10:00  p.m.,  just  after  the  sec- 
ond intermission,  a dashing  young  actor, 
who  was  a known  Confederate  sympathizer, 
named  John  Wilkes  Booth,  entered  the 
front  door  of  the  theatre,  bantered  with 
the  ticket-taker,  who  knew  this  popular 
actor  well,  and  ascended  rapidly  to  the 
dress  circle.  There  he  paused  for  a mom- 
ent while  he  selected  a letter  or  visiting 
card  from  several  in  his  pocket,  to  show 
to  anyone  who  might  challenge  him,  and 
advanced  toward  the  door  of  the  Presi- 
dential box. 

John  Wilkes  Booth  approached  the  box 
according  to  a prearranged  plan  in  which 
he  was  to  kill  Lincoln,  while  an  accom- 
plice, Payne,  was  to  kill  Secretary  of  State 
Seward  simultaneously.  Booth  was  able  to 
get  into  the  box  through  a series  of  fortui- 
tous coincidences,  barricaded  the  door  of 
the  box  with  a device  he  had  secreted  there 
earlier,  and  surveyed  the  box  through  a 
peephole  he  had  made.  He  was  able  to  step 
briskly  through  a door  of  the  anteroom 
and  point  the  pistol  at  Lincoln’s  head, 
without  hesitation.  Lincoln  had  twisted  his 
head  sharply  away,  at  the  moment  the 
shot  was  fired. 


Thus,  the  bullet  entered  the  left  side 
of  the  occiput,  even  though  Booth  was  ap- 
proaching Lincoln  from  Lincoln’s  right. 
The  six  inch,  easily  concealed,  percussion 
Derringer  was  of  a type  which  fired  a large 
ball,  almost  I/2  inch  in  diameter,  of  rela- 
tively low  velocity  but  with  the  force  of  a 
sledgehammer.  A one  inch  disc  of  bone  was 
driven  three  inches  into  the  brain,  and 
the  ball  traveled  throueh  the  brain  a dis- 
tance of  seven  and  one-half  inches,  to  lodge 
above  one  eye.  A fragment  of  the  ball  broke 
off  and  was  lodged  partway  through  the 
track. 

Booth  then  slashed  Major  Rathbone,  who 
had  replaced  General  Grant  as  the  invited 
guest  of  the  evening,  and  climbed  back- 
wards over  the  edge  of  the  box,  catching 
one  spur  on  a picture  and  in  a Treasury 
Department  flag  which  draped  the  front  of 
the  box.  He  was  thrown  off  balance  and 
landed  heavily  on  his  left  foot,  apparently 
breaking  his  fibula  just  above  the  ankle, 
but  making  his  laborious  escape  via  a horse 
which  he  had  left  tethered  outside  the  back 
door  of  the  theatre. 

An  Army  surgeon.  Dr.  Leale,  from  the 
audience,  was  the  first  physician  into  the 
box  after  Major  Rathbone  had  loosened 
Booth’s  barricading  bar  at  the  door  of  the 
Box.  He  found  Lincoln  comatose  and  could 
not  discern  respirations  or  pulse.  He  ap- 
plied mouth  to  mouth  respiration  and 
straddled  the  chest  to  give  closed  chest  “arti- 
ficial respiration’’  (but  pressing  upwards  to 
stimulate  the  heart).  Pulse  and  respiration 
were  restored  and  the  patient  even  ap- 
peared to  swallow  one  teaspoonful  of  di- 
luted brandy,  but  thereafter  would  not 
swallow.  It  was  thought  too  risky  to  move 
Lincoln  to  the  White  House,  so  he  was  then 
moved  to  a bed  in  a rooming  house  across 
from  the  theatre  by  a multiple  hand-carry. 

One  pupil  was  widely  dilated  from  the 
start,  with  the  other  pupil  contracted  at 
first,  but  both  were  unresponsive  to  light. 
About  1 a.m.  both  pupils  became  widely 
dilated  and  fixed,  and  stayed  that  way 
thereafter.  (Conflicting  statements  were  re- 
corded as  to  which  pupil  was  contracted 
at  first.)  The  pulse  was  abnormally  slow 
(40)  except  for  a convulsive  episode  about 
1 a.m.,  at  which  time  it  rose  to  100  for  a 
short  period.  Whenever  the  drainage  of 
blood,  fluid  and  brain  tissue  from  the 
wound  would  slow,  the  respirations  would 
become  labored,  but  would  improve  when 


for  November,  1970 


515 


the  coagulum  was  removed.  Respirations 
become  progressively  more  labored  and  in- 
termittent until  they  ceased  (some  nine 
hours  after  the  shooting)  at  7:21  and  55 
seconds  a.m.,  and  pulse  became  impercept- 
ible at  7:22  and  10  seconds  a.m. 

Five  hours  after  death,  an  autopsy  was 
performed  at  the  White  House,  and  only 
the  cranium  was  opened.  The  bullet  was 
found  to  have  torn  across  the  left  lateral 
venous  sinus,  and  traveled  through  the 
brain  for  a distance  of  seven  and  one-half 
inches,  inflicting  extensive  damage  along 
its  track  which  was  clearly  visible  through 
the  hemorrhagic  and  “pultaceous”  brain 
substance.  There  appears  little  room  for 
any  possibility  that  Lincoln  might  have  sur- 
vived, because  of  the  contamination  of  the 
wound  with  multiple  foreign  bodies,  prob- 
able hair,  skin  and  possible  fragments  of 
greased  patch  or  paper  wadding  which  ac- 
companied the  bullet  within  the  brain,  the 
probing  by  unsterile  fingers  and  probes, 
and  the  probability  that  a large  soft  tissue 
cavity  had  formed  within  the  brain  at  the 
moment  of  impact. 

Could  Lincoln  Have  Survived? 

Could  modern  neuro  surgical  techniques, 
blood  transfusions,  supportive  and  anti-bac- 
terial therapy  have  made  it  possible  for  Lin- 
coln to  have  survived,  had  he  been  shot  in 
1964,  99  years  later,  instead  of  1865? 

Many  competent  authorities  have  ex- 
pressed themselves  without  reservation‘s  that 
Lincoln  could  not  possibly  have  survived. 
The  large  projectile,  striking  the  head  with 
the  force  of  a sledge  hammer  had  driven 
a disc  of  bone  almost  one  inch  in  diameter 
ahead  of  it  through  the  lateral  venous 
sinus,  across  the  meninges,  and  into  the 
brain  to  a depth  of  three  inches.  A fragment 
of  metal  the  size  of  a modern  dime  had 
torn  off  and  was  left  in  the  track,  and  the 
balance  of  the  projectile  had  travelled  a 
distance  of  seven  and  one-half  inches 
through  the  brain  to  lodge  almost  at  the 
other  side  of  the  skull.  The  combination 
of  foreign  material  scattered  in  a track 
through  the  center  of  the  brain  would  have 
been  impossible  to  locate  and  clean  out,  as 
any  experienced  wartime  surgeon  knows. 

In  addition,  the  brain  had  been  probed 
to  the  full  length  of  the  unsterile  fingers  of 
at  least  two  of  the  doctors  who  attended 
him,  in  an  attempt  to  locate  the  ball,  and 


with  two  unsterile  probes,  a silver  one  ap- 
proximately six  inches  long,  and  a porce- 
lain tipped  rubber  “Nelaton”  probe,  to  a 
distance  of  seven  and  one-half  inches.  The 
principles  of  aseptic  technique,  and  indeed 
the  knowledge  of  germs  as  the  cause  of 
wound  infections  were  unknown  in  Lincon’s 
day,  and  while  occasional  Civil  War  soldiers 
were  reported  to  have  recovered  from  bul- 
let wounds  of  the  brain,  these  were  ob- 
viously very  rare  exceptions. 

The  autopsy  report  that  the  track  of  the 
bullet  could  be  easily  distinguished  because 
of  the  extensive  destruction  and  the  pres- 
ence of  pultaceous  brain  material  along  the 
track  points  up  the  tremendous  damage, 
but  does  not  take  into  account  the  further 
damage  which  is  now  known  to  result  from 
the  momentary  creation  of  a large  cavity 
in  the  brain,*  when  it  is  struck  by  a missile 
traveling  at  the  speed  of  a bullet.  There 
seems  to  be  no  reason  to  disagree  with  those 
who  have  stated  that  Lincoln  could  not 
possibly  have  survived  this  wound,  even  in 
modern  times,  and  that,  indeed,  it  is  re- 
markable that  he  survived  for  about  nine 
hours.  Even  if  he  had  survived,  he  most 
certainly  would  have  been  a decerebrate 
“vegetable,”  a cruel  transformation  from 
the  sensitive,  compassionate  and  thought- 
ful Chief  of  State,  which  he  had  been. 
Death  probably  spared  him  a vicious  cam- 
paign of  character  assassination  and  defa- 
mation which  would  have  accompanied  his 
avowed  attempts  to  curb  post-war  profi- 
teering, exploitation  and  vengence  directed 
at  the  prostrate  South.  As  it  was,  assassina- 
tion at  the  very  peak  of  his  popularity,  en- 
shrined him  forever  in  the  history  of  the 
world. 

References 

1.  Otto  Eisenschiml:  Why  was  Lincoln  Mur- 
dered? Little  Brown  and  Company,  Boston, 
Massachusetts,  1937. 

2.  Sandburg,  Carl:  Abraham  Lincoln,  Vol.  IV, 
Harcourt,  Brace  and  Company,  New  York, 
1939. 

3.  Leale,  Charles  A.,  M.D.:  Lincoln’s  Last 

Hours,  (booklet).  Courtesy  Helen  Leale  Har- 
per, Jr.,  Pelham,  New  York,  1964. 

4.  Curtis,  Dr.  Edward  A.:  Last  Professional 

Service  of  the  War.  Glimpses  of  Hospital 
Life  in  Wartimes.  Vol.  4:63-6.5,  1865. 

5.  Taft,  Dr.  C.  S.:  "The  Last  Hours  of  Abraham 
Lincoln,”  Med.  and  Surg.  Rep.,  Vol.  12,  452-54, 
1865. 

6.  Woodward,  J.  J.:  “Handwritten  Report  of  the 
Autopsy  on  President  Lincoln.”  Original  in 
Surgeon  General’s  Office,  Wash.  D.G.  April 
15,  1865. 


Illinois  Medical  Journal 


7.  Eisenschiml:  The  Case  of  A.L.— , Aged  56;  8.  Wound  Ballistics,  Medical  Department,  U.S. 

The  Abraham  Lincoln  Bookshop,  Chicago,  Illi-  Army,  Washington  D.C.,  1902. 

nois,  1943. 

Surgeon  General’s  Office 
Washington  City,  D.C. 

April  15  th,  1865 

Brigadier  General  f.  K.  Barnes 

Surgeon  General  U.S.A. 

General: 

I have  the  honor  to  report  that  in  obedience  to  your 
orders  and  aided  by  Assistant  Surgeon  E.  Curtis,  U.S. A.,  I 
made  in  your  presence  at  12  o’clock  this  morning  an  au- 
topsy on  the  body  of  President  Abraham  Lincoln,  with  the 
following  results.  “The  eyelids  and  surrounding  parts  of 
the  face  were  greatly  echymosed  and  the  eyes  somewhat 
protuberant  from  effusion  of  blood  into  the  orbits. 

There  was  a gunshot  wound  of  the  head  around  which 
the  scalp  was  greatly  thickened  by  hemorrhage  into  its  tis- 
sues. The  ball  entered  through  the  occipital  bone  about 
one  inch  to  the  left  of  the  median  line  and  just  above  the 
left  lateral  sinus,  which  it  opened.  It  then  penetrated  the 
dura  mater,  passed  through  the  left  posterior  lobe  of  the 
cerebrum,  entered  the  left  lateral  ventrical  and  lodged 
in  the  white  matter  of  the  cerebrum  just  above  the  anterior 
portion  of  the  left  corpus  striatum,  where  it  was  found. 

The  wound  in  the  occipital  bone  was  quite  smooth,  cir- 
cular in  shape,  with  bevelled  edges.  The  opening  through 
the  internal  table  being  larger  than  that  through  the  ex- 
ternal table.  The  track  of  the  ball  was  full  of  clotted  blood 
and  contained  several  little  fragments  of  bone  with  a small 
piece  of  the  ball  near  its  external  orifice.  The  brain  around 
the  track  was  pultaceous  and  livid  from  capillary  hemor- 
rhage into  its  substance.  The  ventricles  of  the  brain  were 
full  of  clotted  blood.  A thick  clot  beneath  the  dura  mater 
coated  the  right  cerebral  lobe. 

There  was  a smaller  clot  under  the  dura  mater  of  the 
left  side.  But  little  blood  was  found  at  the  base  of  the 
brain.  Both  the  orbital  plates  of  the  frontal  bone  were 
fractured  and  the  fragments  pushed  upwards  towards  the 
brain.  The  dura  mater  over  these  fractures  was  uninjured. 

The  orbits  were  gorged  with  blood.  I have  the  honor  of 
being  very  respectfully  your  obedient  servant. 

E.  J.  J.  Woodward 
Assistant  Surgeon 
U.S.A. 


How  Federal  Pay  is  Growing 

Any  wage  gap  between  federal  employees  and  those  in  private  industry 
is  now  in  favor  of  government  workers.  Commerce  Department  figures 
show  that  last  year  the  annual  average  earnings  of  full-time  government 
workers  reached  $7,131,  $70  more  than  those  of  private  industry  employ- 
ees, and  an  increase  of  $1,155  over  three  years. 


for  November,  1970 


517 


Fibromas  (fibromatoses)  represent  a comparatively  rare 
tumor  of  omentum  and  mesentery.  A fairly  recent  review 
of  the  literature^  listed  35  acceptable  case  reports  and  added 
12  new  observations.  Three  additional  cases  have  been  re- 
ported since.^'^'’> 

A giant  fibroma  of  the  mesentery  was  observed  recently 
in  this  institution,  its  presence  being  recognized  after  the 
termination  of  a normal  pregnancy. 

Giant  fibroma 


(Fibromatosis ) 
Of  mesentery 

By  Henry  P.  Lattuada,  M.D.,  Mario  Stefanini,  M.D., 
AND  Lewis  C.  Powell.  M.D.. /Danville 


Case  Report 

A 23-year-old  woman  was  admitted  on 
July  27,  1968,  during  her  seventh  month  of 
pregnancy,  complaining  of  cramping  pain 
in  the  right  flank  and  upper  abdomen.  Two 
previous  pregnancies  had  terminated  in 
normal  full-term  deliveries.  She  was  not 
in  labor.  Abdominal  examination  revealed 
that  the  baby  was  in  the  vertex  position. 
The  fetal  head  was  not  engaged  and  the 
fetal  heart  tones  were  audible.  No  other 
intra-abdominal  enlargement  except  the 
pregnant  uterus  was  discernible.  Flat  plate 
of  the  abdomen,  gall  bladder  series  and 
IVP  indicated  a pregnant  uterus  along  with 
a non-functioning  gall  bladder  and  a nor- 
mal urinary  tract.  A diagnosis  of  false  labor 
was  made  and  the  patient  was  discharged. 
She  was  seen  twice  in  the  office  complain- 


ing only  of  pressure  and  discomfort  in  the 
right  side  of  the  abdomen.  On  September 
29,  1968,  the  patient  returned  to  the  hos- 
pital with  a similar  complaint.  Six  days 
later  she  delivered  spontaneously  and  un- 
eventfully a normal  living  female  infant 
weighing  3,820  gms.  The  palpation  of  the 
abdomen,  after  delivery,  revealed  a large, 
lobulated,  firm,  movable  mass  to  the  right 
of  and  higher  than  the  uterus,  extending 
toward  the  flank.  A diagnosis  of  retroperi- 
toneal tumor  or  of  large  ovarian  cyst  was 
made.  Repeated  X-ray  studies  showed  cho- 
lelithiasis in  a normally  functioning  gall 
bladder  and  a large  intra-abdominal  mass 
displacing  loops  of  bowel  and  causing  in- 
trinsic pressure  on  the  right  ureter.  Routine 
laboratory  studies  were  within  normal 
limits. 


Henry  P.  Lattuada,  M.D.,  Danville,  (left)  is  an  obstetrician- 
gynecologist  on  the  staffs  of  Lakeview  Memorial  Hospital  and  St. 
Elizabeth’s  Hospital.  A Diplomate,  American  Board  of  Obstetrics 
and  Gynecology  and  Fellow,  American  College  of  Surgeons,  Dr. 
Lattuada  is  also  a Founding  Fellow  of  the  American  College  of 
Obstetricians  and  Gynecologists,  and  a member  of  the  Central 
Association  of  Gynecologists  and  Obstetricians.  Mario  Stefanini, 
M.D.,  (right)  is  a pathologist  and  Director  of  Laboratories,  St. 
Elizabeth’s  Hospital,  Danville.  Dr.  Stefanini  is  a Diplomate, 
American  Board  of  Pathology,  and  the  editor  and  author  of  texts 
in  his  field.  He  is  a graduate  of  the  Medical  School,  University  of 
Rome  and  received  an  M.Sc.  degree  from  Marquette  University. 
Lewis  C.  Powell,  M.D.,  (not  shown)  is  a pathologist  on  the  staff 
of  St.  Elizabeth’s  Hospital. 


518 


Illinois  Medical  Journal 


Fig.  1.  Fibromatosis  (giant  fibroma)  of  mesentery  at  surgery. 
(A)  anterior  view  (B)  lateral  view. 


Surgery  was  carried  out  on  October  14, 
1968.  At  laparotomy  under  2-bromo-2 
chloro- 1,1,1  trifluoro-ethane  (halothane) 
anesthesia,  the  involuting  uterus.  Fallopian 
tubes  and  ovaries  were  identified.  A large, 
irregular,  smooth,  solid  tumor  occupied  the 
space  between  the  leaves  o£  the  mesentery 


of  the  terminal  ileum  and  ascending  colon 
(Fig.  1,  a &:  b).  The  appendix  was  stretched 
over  the  surface  of  the  tumor.  This  was 
delivered  from  the  abdomen,  together  with 
tightly  adherent  portions  of  the  terminal 
ileum  and  ascending  colon,  and  mobilized 
after  ligating  its  blood  supply  which  was 


for  November,  1970 


519 


represented  by  branches  of  the  ileo-colic 
artery.  Small  bowel  and  inferior  aspect  of 
the  cecum  were  separated  from  the  tumor, 
while  the  appendix  was  removed  with  it. 
As  the  blood  supply  to  the  cecal  area  had 
been  likely  compromised,  the  distal  por- 


tion of  the  ileum  and  of  the  proximal  as- 
tending  colon  were  removed,  this  step  be- 
ing follow'ed  by  end-to-end  anastomosis 
between  cecum  and  ascending  colon.  The 
jjatient  made  an  uneventfid  recovery.  There 
is  no  recurrence  of  tumor  one  year  later. 

Pathologic  findings 

The  specimen  consisted  of  a large,  hard, 
yellowish  mass,  weighing  1,030  gms.  and 
measuring  21x16x12  cm.  A few  superficial 
cystic  bosselations  were  present,  umbilicated 
centrally,  measuring  up  to  1.5x1  cm.  The 
appendix  vermiformis,  9 cm.  long,  was  at- 
tached to  the  mass  through  fibrous  bands. 
On  section,  the  tumor  appeared  firm,  fi- 
brous and  gritty.  The  cut  surface  oozed  a 
small  volume  of  clear  liuid.  There  were  ir- 
regularly branching  and  hbrous  trabecu- 
lae, o]iaque  and  greyish-white.  Many  inter- 
vening areas  were  translucent,  pale  and 
tannish-giey,  almost  myxomatous  in  appear- 
ance. In  the  center  of  the  mass  was  a cystic 
cavity,  measuring  8x6. 5x6  cm.,  containing 
yellowish,  serous  fluid,  and  surrounded  by 
numerous  smaller  cavities  (Fig.  2).  Also 
received  were  15  cm.  of  ileum  and  16  cm. 
of  colon,  showing  dusky  wall. 


Microscopic  sections  of  the  tumor  (Fig.  3) 
showed  a collagenous  stroma  arranged  in 
broad,  interlacing,  strap-like  bands  of  in- 
tensely acidophilic  material  and  in  bundles 
running  in  various  directions.  There  were 
areas  of  necrobiosis  resulting  in  cyst  for- 


mation and  hyaline  transformation  of  col- 
lagen was  frequent.  Many  areas  showed 
few  benign  appearing  spindle  cells.  The 
blood  vessels  scattered  through  the  lesion 
were  unremarkable.  The  portions  of  ileum 
and  of  ascending  colon  showed  congestion 
of  vessels. 

Comment 

Benign  tumors  of  the  mesentery,  and  fi- 
bromatoses among  them,  do  not  present 
characteristic  clinical  findings.  They  are 
asymptomatic  in  the  early  stages,  and  when 


Fig.  3.  Microscopic  section  of  tumor  (H 
& E).  Note  the  cellagenous  stroma  ar- 
ranged in  bundles  running  in  various  di- 
rectious  and  separating  benign  appearing 
spindle  cells. 


Fig.  2.  Fibromatosis  (giant  fibroma)  of  mesentery. 
Appearance  of  surface  section  of  tumor.  (See  text.) 


520 


lUinois  Medical  Journal 


discovered,  they  usually  measure  between 
10  and  20  cm.  in  diameter.  Then,  signs  of 
mechanical  compression  begin  to  appear 
(vague  pain  and  abdominal  discomfort, 
constipation,  frequency,  nausea  and  vomit- 
ing) as  well  as  unexplained  loss  of  weight. 
X-ray  findings  are  for  the  most  part  equi- 
vocal, indicating  displacement  of  the  bowel 
without  intrinsic  distortion.  These  large 
tumors  infiltrate  the  leaves  of  the  mesentery 
and  serosa  of  bowel.  Thus,  because  of  ad- 
herence to  the  bowel  and  the  likelihood  of 
recurrence  after  incomplete  excision,^  - the 
entire  tumoral  mass  must  be  excised  and 
portions  of  small  and  large  intestine  are 
likely  to  be  sacrificed  as  well. 

Our  patient  is  apparently  the  first  case 
in  which  a giant  fibroma  was  associated 
with  pregnancy.  Thus,  the  vague  symptoms 
which  could  have  drawn  attention  to  the 
tumor  were  attributed  to  pregnancy.  Be- 
cause of  the  frequent  association  of  fibroma- 
toses with  Gardner-Stephens’  syndrome,'"’ 
evidence  of  intestinal  polyposis,  epidermoid 
cysts,  leiomyomas  or  bone  tumors  was 
sought  in  the  patient  and  her  relatives, 
without  success.  There  was  no  familial  his- 
tory of  carcinoma  of  the  gastro  intestinal 


tract.  Thus,  this  case  represents  another  in- 
stance of  idiopathic  fibromatosis  of  the 
mesentery.  Its  rarity  and  its  association  with 
pregnancy  warrant  this  report. 

Abstract 

A case  of  giant  fibroma  (fibromatosis)  of 
the  mesentery  was  discovered  at  explora- 
tory laparotomy  in  a patient  who  had  de- 
livered recently.  The  tumor  was  excised, 
along  with  adjacent  portions  of  ileum  and 
of  ascending  colon.  There  was  no  evidence 
of  concurrent  Gardner-Stephens’  syndrome. 
There  has  been  no  demonstrable  recurrence 
of  the  tumor  within  one  year.  <4 

References 

1.  Yannopoulos,  K.  and  Stout,  A.P.,  “Primary  solid 
tumors  of  the  mesentery,’’  Cancer,  16:914-927, 
1963. 

2.  Smith,  E.  B.,  “Giant  fibroma  of  the  mesentery,” 
/.  Nat.  M.A..  61:319-320,  1969. 

3.  .Adams,  J.  T.  and  Kutner,  F.  R.,  “Pure  fibroma 
of  the  mesentery,”  Am.  ].  Surg.,  111:734-739, 
1966. 

4.  Colcock,  B.  P.  and  Braasch,  J.  W.,  Surgery  of 

THE  SMALL  INTESTINE  IN  THE  ADULT,  W.  B.  Saun- 

ders  Co.,  Philadelphia,  Penn.,  1968,  page  83. 

5.  Gardner,  E.  J.  and  Stephens,  F.  E.,  “Cancer  of 
the  lower  digestive  tract  in  one  family  group,” 
Am.  J.  Med.  Genet.,  2:41-48,  1950. 


School  physician  does  as  told 

The  fact  that  the  school  physician  apparently  does  as  he  is  told  may  help 
explain  the  fact  that  he  is,  in  general,  satisfied  with  his  job  (as  reported 
in  a study  on  attitudes  of  these  same  school  physicians  toward  their  work). 
This  may  be  so  in  spite  of  the  fact  that  he  also  feels  that  the  current  school 
health  program  is  not  meeting  what  he  feels  are  the  most  important  health 
needs  of  the  children  in  these  schools.  Apparently,  the  physician  working 
in  a large  school  district  carries  out  specific  duties  as  directed  by  others 
in  the  system— no  matter  what  his  own  personal  characteristics  are,  what 
his  professional  training  has  been,  or  what  his  attitudes  and  beliefs  are  con- 
cerning ihe  health  needs  of  school-age  children. 

What  are  the  impl'cat'ons  of  these  findings?  If  physicians  are  willing  to 
do  as  they  are  told  when  working  in  a large  health  system,  it  does  not  seem 
reasonable  to  suppose  that  changes  in  the  curriculum  in  medical  schools 
or  in  the  postgraduate  training  programs  will  influence  the  activities  of 
these  same  physicians  in  large  health  programs.  It  appears,  rather,  that 
any  needed  changes  must  come  from  the  leaders  of  large  health  services 
where  the  decisions  are  made  concerning  administrative  recommendations 
for  physician  activities.  The  importance  of  the  quality  of  personnel  in  the 
positions  of  leadership  in  health  service  programs  would  appear  to  be 
great  in  view  of  the  findings.  With  the  urgent  physician  manpower  short- 
age and  with  the  large  number  of  physicians  spending  thousands  of  man- 
hours in  our  schools,  it  seems  imperative  that  a new,  long,  hard,  realistic 
look  be  given  to  what  school  physicians  are  being  told  to  do.  (Marsden 
C.  Wagner  et  al.:  A Studv  of  the  Determinants  of  School  Physician  Behavior. 
Americcn  Journal  of  Public  Health  60:8,  (Aug.)  1970,  pages  1435-1438.) 


for  November,  1970 


521 


Pathology 

of 

Ocular  trauraa 


By  Milton  M.  Scheffler,  M.D./  Chicago 

The  material  to  be  presented  deals  with  eyes  enucleated  because 
of  severe  trauma,  mechanical  in  character,  which  resulted  in  com- 
plete disarrangement  of  the  visual  apparatus.  The  type  of  injury 
was  of  two  major  varieties;  penetrating;  and  non-penetrating,  the 
latter  that  of  blunt  trauma. 

The  following  three  topics  will  be  discussed: 

1.  Retained  Foreign  Bodies 

2.  Epithelial  Implants  and  Down  Growth 


3.  Blunt  Trauma 

Retained  foreign  bodies 

Cilia:  These  will  frequently  be  seen 
within  the  globe  following  injuries  by  glass 
or  sharp  objects  affecting  the  lid  borders. 
When  in  the  cornea,  they  may  often  be 
the  cause  of  a fistulizing  wound  and  poor 
healing. 

Case  51-39:  A corneo-scleral  laceration  re- 
sulted in  an  iris  prolapse  and  vitreous  loss. 
On  microscopic  exam,  the  cause  of  the 
faulty  wound  closure  and  partial  epithelial 
down  growth  was  seen  to  be  a retained 
cilia  in  the  wound. 

Case  52-2:  A fistulizing  wound  of  the 
cornea  following  trauma,  necessitated  a 
corneal  transplant.  Microscopically,  a cilia 
was  found  as  the  cause  of  the  failure  of  the 
cornea  to  heal. 

Frequently,  an  unsuspecting  foreign  body 
is  found  on  microscopic  examination,  be- 
cause enucleation  was  indicated  in  an  eye 
responding  poorly  to  therapy. 


Case  49-12:  A corneal  laceration  occurred 
from  the  broken  end  of  a Venetian  blind 
There  was  iris  and  lens  prolapse  with  an 
anterior  chamber  hemorrhage.  Because 
the  eye  did  poorly,  enucleation  became 
necessary  at  the  end  of  six  weeks.  Micro- 
scopically, a retained  piece  of  wood  was 
seen  embedded  in  the  posterior  sclera, 
having  penetrated  the  retina  and  chorod. 
A foreign  body  reaction  about  the  retained 
substance  was  quite  prominent,  consisting 
of  giant  cells  and  epitheloid  cells.  The 
edema  and  infiltration  of  the  nerve  head 
were  indicative  of  an  optic  neuritis. 

The  retention  of  metal  following  a pen- 
etrating injury  can  ultimately  result  in 
loss  of  the  eye  because  of  the  toxic  prod- 
ucts produced.  When  a penetrating  injury 
is  suspected  or  visualized,  an  X-ray  of  the 
eye  and  orbit  is  essential  and  of  medico- 
legal importance.  If  the  object  is  radio- 
opaque, and  retained  in  the  globe,  its  pres- 


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Illinois  Medical  Journal 


ence  can  be  visualized  readily  and  steps 
taken  for  its  removal.  Accurate  localization 
is  very  important  to  facilitate  removal  of 
the  foreign  body  without  further  trauma 
to  the  vital  ocular  structures. 

Case  48-36:  The  microscopic  picture  of 
Siderosis  of  the  bulb  was  produced  from  an 
unsuspecting  retained  metal  foreign  body. 
The  injury  occurred  approximately  one 
year  ago  while  the  patient  was  working 
with  a hammer  and  chisel.  At  the  time  of 
the  enucleation,  the  eye  was  blind.  The 
anterior  chamber  was  very  shallow  due  to 
the  forward  displacement  of  the  iris— lens 
diaphragm  from  a swollen  cataractous  lens, 
with  a brownish  discoloration.  The  ap- 
pearance suggested  a Siderosis  of  the  bulb, 
and  an  X-ray  revealed  the  presence  of  the 
foreign  body. 

Microscopically  it  is  noted  that  the  dis- 
solved iron  compound  is  absorbed  by  the 
epithelial  structures  of  the  globe,  the  dilator 
and  sphinctor  of  the  iris,  the  epithelium  of 
the  lens,  the  non-pigmented  epithelium  of 
the  ciliary  body  and  the  retina. 

The  presence  of  the  diffusible  iron  com- 
pound first  results  in  an  irritative  pheno- 
mena, followed  by  destruction  of  the  visual 
apparatus. 

Case  55-31 : A penetrating  foreign  body 
was  visualized  by  X-ray  just  below  the  hori- 
zontal plane,  temporally,  and  8 mm  behind 
the  center  of  the  cornea.  Some  eight  days 
later  an  attempt  was  made,  unsuccessfully, 
to  remove  the  foreign  body,  by  way  of  a 
posterior  sclerotomy  incision.  Eight  days 
after  surgery,  the  eye  was  enucleated.  There 
was  a partial  hyphema  and  an  opaque 
lense. 

Microscopically,  the  cornea  is  blood-stain- 
ed and  a healing  corneal  perforation  is 
visualized  with  the  iris  adherent  to  the  post- 
erior corneal  surface.  The  wound  is  seen 
to  traverse  the  ciliary  body,  indicating  the 
path  of  the  foreign  body  with  injury  to 
the  nasal  equator  of  the  lens.  The  foreign 
body  was  ultimately  seen  in  the  posterior 
pole  of  the  eye,  surrounded  by  a localized 
abscess  in  the  vitreous.  The  site  of  the  pos- 
terior sclerotomy  wound  remained  un- 
healed. Healing  of  scleral  wounds  are  the 
result  of  proliferation  of  the  episcleral  as 
well  as  the  suprachorodal  tissue,  since  the 
sclera  itself  is  inert. 

The  very  early  removal  of  intra  ocular 
foreign  bodies  is  essential  to  the  survival 


of  the  visual  function.  The  site  for  its 
removal  should  allow  for  a minimum  of 
trauma  to  an  already  traumatized  eye. 

Epitheleal  downgrowth  and 
implantation  cysts 

This  group  of  cases  is  characterized  by 
the  presence  of  epithelium  within  the  ocular 
structure,  resulting  as  a rule  from  poor 
or  delayed  wound  closure,  or  the  implan- 
tation of  epithelium  following  a penetrating 
injury. 

Epithelial  downgrowth 

The  essential  feature  is  a poorly  closed 
wound,  whether  it  be  due  to  incarcerated 
tissue  such  as  iris,  lens  or  vitreous,  or 
poor  apposition  of  the  wound  lips,  what- 
ever the  cause.  The  surface  epithelium 
grows  down  between  the  wound  lips  into 
the  anterior  chamber,  where  it  will  ulti- 
mately line  the  posterior  corneal  surface, 
the  angle  and  cover  the  anterior  iris  sur- 
face. In  the  presence  of  a vascular  supply, 
it  will  grow  luxuriously  over  the  iris  sur- 
face, but  remain  thin  on  the  posterior 
cornea. 

Its  presence  will  be  manifested  by  a 
greyish  veil  on  the  posterior  cornea,  pro- 
gressing, associated  with  an  irritable  eye 
and  ultimately  a secondary  glaucoma,  which 
does  not  respond  to  therapy. 

Case  62-13:  A corneo  scleral  laceration 
was  repaired,  followed  by  an  irritable  eye. 
Epithelial  cysts  were  ultimately  seen  in  the 
anterior  chamber.  Microscopically,  a gap- 
ing, healed  corneo-scleral  wound  is  noted, 
lined  by  epithelium,  which  is  seen  to  extend 
throughout  the  anterior  and  posterior 
chamber.  The  iris  is  heavily  infiltrated  with 
plasma  cells. 

Case  55-101:  The  case  presented  with 
a secondary  glaucoma  and  a dark  area  in 
the  inferior  temporal  sector  which  suggested 
a possible  tumor.  Microscopically,  an  un- 
usual epithelial  downgrowth  was  demon- 
strated. It  extended  from  the  lips  of  the 
scleral  wound,  the  site  of  the  dark  mass,  ex- 
tending forward  in  the  supra  choroid,  la- 
mina fusca  of  the  ciliary  body  and  into  the 
anterior  chamber. 

There  was  no  history  of  trauma  or  a sur- 
gical procedure,  yet  the  nature  of  the 
course  of  the  epithelium  suggested  a cyclo- 
dialysis. 


/or  November,  1970 


523 


Epithelial  implantation  cysts 

These  result  from  the  implantation  of 
epidermal  cells  or  surface  epithelium  fol- 
lowing a penetrating  injury.  The  epidermis 
about  the  lashes  is  a common  offender.  The 
epithelium  thus  inplanted,  may  grow  as  a 
solid  tumor  to  form  the  Pearl  Cysts  or  with 
central  liquifaction,  form  a transluscent 
cyst,  lined  by  epithelium. 

Case  52-3:  The  eye  had  been  injured  at 
the  age  of  12  years.  Now  at  the  age  of  74, 
the  eye  was  painful,  red,  with  considerable 
tearing.  There  was  an  elevated,  protrusion 
of  the  cornea,  5 mm  in  diameter,  which  on 
slit  lamp  was  due  to  an  ectasia  of  the  anter- 
ior corneal  layers.  Microscopically,  there 
was  a central  edematous  fibrous  tissue  con- 
taining an  epithelial  lined  cyst. 

Case  6S-S:  Following^  a penetrating  in- 
jury, a small  epithelial  plug  is  seen  im- 
planted in  the  iris.  This  illustrates  the  on- 
lage  of  the  implantation  pearl  cyst. 

Case  52-57:  At  the  age  of  17  years,  a 
dark  mass  was  noted  on  the  iris.  A pro- 
phylactic iridectomy  revealed  a large  im- 
plantation cyst.  The  history  of  trauma  was 
({uite  obscure. 

Case  61-11:  This  child  suffered  a pene- 
trating wound  about  the  lower  limbal  area, 
successfully  repaired.  Ffe  subsequently  re- 
turned with  a visible  large  cyst  inferiorly 
in  the  anterior  chamber.  A diagnosis  of  an 
iris  implantation  cyst  was  confirmed  mic- 
roscopically, following  an  iridectomy  at  the 
site  of  the  cyst. 

Case  -19-S:  There  had  been  periodic  at- 
tacks of  pain  in  the  eye  following  a 
penetrating  injury  some  27  years  ago.  The 
attacks  became  quite  severe  prior  to  enu- 
cleation with  the  clinical  picture  of  an 
acute  secondary  glaucoma.  Microscopically, 
a solid  epithelial  plug  fills  the  iris. 

Case  54-77:  This  most  unusual  case  oc- 
cured  in  a 4-year-old  with  no  previous  his- 
tory of  trauma.  A grey  area  was  first  noted 
in  the  cornea  with  a visual  acuity  of  20/20. 
Ihe  opacity  progressed  over  a period  of 
years  until  the  entire  central  area  was  in- 
volved. The  clinical  diagnosis  was  a lipoid 
dystrophy  or  possible  dermoid.  At  the  time 
of  the  penetrating  corneal  transplant,  as 


Milton  M.  Scheffler,  M.  D.,  is  an  attending 
ophthalmologist  at  Michael  Reese  and  Cook 
County  Hospitals,  and  assistant  professor  in 
the  Department  of  Ophthalmology  at  North- 
western University  Medical  School. 


the  cornea  was  cut,  a milky  fluid  escaped. 
The  microscopic  picture  was  most  enlight- 
ening. There  were  two  corneal  layers,  lined 
on  its  adjoining  surfaces  by  a layer  of  epi- 
thelium. The  deep  corneal  stroma  was 
heavily  scarred  and  vascularized.  The  diag- 
nosis was  an  intracorneal  epithelial  implan- 
tation cyst. 

Non-penetrating  injuries — blunt  trama 

Blunt  trauma  to  the  globe,  insufficient  to 
cause  rupture  of  the  ocular  coats,  may  still 
cause  considerable  damage.  The  pathology 
visible  will  vary,  and  is  dependent  upon: 
1)  damage  to  the  cells  causing  a distur- 
bance in  physiologic  activity;  2)  the  degree 
of  vascular  reaction;  3)  mechanical  trauma 
to  the  tissue.  Rupture  and  displacement  of 
the  uveal  tract,  lens,  retina  and  optic  nerve 
may  result. 

Hyphema,  the  result  of  injury  to  the 
ciliary  body  or  iris,  if  associated  with  a pro- 
longed secondary  glaucoma,  may  result  in 
blood  staining  the  cornea.  This  may  occur 
even  in  soft  eyes,  if  the  endothelial  cells 
have  been  damaged.  Iris  contusions  may 
result  in  a variety  of  finding.  The  trauma 
initially  produces  a marked  edema  followed 
by  subsequent  necrosis,  especially  with  an 
elevated  pressure. 

Case  5"i-14:  Illustrates  the  picture  of 
blood  staining  from  prolonged  hyphema 
as  well  as  a developing  iris  necrosis  in  a 
hypertensive  globe. 

Ruptures  of  the  iris  at  its  insertion  in  the 
ciliary  body,  iridodialysis,  is  a frequent 
cause  of  a severe  anterior  chamber  hemorr- 
hage and  subsequent  secondary  glaucoma. 
This  is  well  demonstrated  in  Case  49-71. 

Traumatic  cyclo-dialysis,  a tear  thru  the 
scleral  spur,  with  separation  of  the  ciliary 
body,  will  also  cause  considerable  hemorr- 
hage. Case  49-56,  not  only  reveals  this,  but 
also  a posterior  scleral  rupture. 

A more  serious  affliction  is  a tear  thru 
the  anterior  surface  of  the  ciliary  body  into 
the  stroma,  resulting  in  a deepening  of  the 
anterior  chamber  and  the  development  of 
a glaucoma  at  a later  date  which  responds 
poorly  to  therapy.  The  immediate  effect 
is  a severe  hemorrhage,  due  to  damage  to 
the  major  circle  of  the  iris. 

Case  62-81:  This  eye  suffered  blunt 
trauma  in  childhood  and  now  at  the  age 
of  56,  there  had  been  progressive  visual  loss 
for  the  past  five  years.  The  eye  prior  to 


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Illinois  Medical  Journal 


enucleated  was  red,  painful  and  hard. 
The  microscopic  picture  is  typical  of  the 
angle  recession  glaucoma,  with  the  trabecu- 
lar area  and  tear  covered  by  a new  formed 
Descements  membrane. 

Case  49-59:  This  was  the  eye  of  a box- 
er who  had  repeated  blunt  trauma  to  the 
eye.  The  presence  of  a dislocated  lens,  sec- 
ondary glaucoma,  and  multiple  organized 
subretinal  hemorrhages  with  destruction  of 
the  rods  and  cones  is  a mute  testimony  to 
the  hazards  of  this  occupation. 

Case  51-51:  Blunt  trauma  resulted  in  an 
“eight  ball’’  hyphema  with  secondary  glau- 
coma and  blood  staining  of  the  cornea. 
Treatment  was  refused  and  when  the  eye 
was  enucleated  one  year  later,  there  was 
corneal  scarring,  necrosis  and  scar  tissue 
replacement  of  the  ciliary  body  with  an 
intercalary  staphyloma  on  the  opposite  side. 

Case  54-16:  Blunt  trauma  occurred  in 
May  and  when  examined  in  July,  there  was 
evidence  of  a detached  retina  with  tears 
and  retinal  hemorrhage.  In  October,  the 
uninvolved  eye  revealed  a mild  anterior 
and  posterior  uveitis.  The  microscopic  pic- 
ture of  the  enucleated  traumatized  eye  re- 
vealed a healed  choridal  rupture  without 
evidence  of  interruption  of  the  scleral  con- 
tinuity and  a granulomatous  choroidal 
nodule  histologically  resembling  sympath- 
etic ophthalmia.  This  later  finding  is  rather 
unusual. 


In  this  last  group  of  cases,  the  blunt 
trauma  was  of  sufficient  force  to  result  in 
rupture  of  the  globe.  This  usually  occurs 
at  the  site  of  the  trauma,  but  more  often 
at  an  anatomically  weak  site,  anteriorly, 
in  the  vicinity  of  Schlemns  canal,  and  fre- 
quently associated  with  dislocation  and  loss 
of  the  lens  through  the  tear;  about  the  thin 
equator  or  site  of  the  exit  of  the  vortex 
veins,  and  posteriorly,  in  the  vicinity  of  the 
perforating  short  ciliary  vessels. 

The  diagnostic  phenomena  of  an  ex- 
ceedingly low  tension  is  significant  in  post- 
erior ruptures.  Massive  intra-ocular  hemorr- 
hage is  usually  an  accompanying  finding 
of  the  ruptured  globe. 

Case  49-74:  Rupture  in  the  vicinity  of 
Schlemns  canal  with  loss  of  lens  and  pro- 
lapse of  iris  and  ciliary  processes  with  mas- 
sive anterior  chamber  hemorrhage. 

Case  49-70:  Scleral  rupture  over  the  pars 
plana  with  prolapse  of  ciliary  body,  retina 
and  vitreous.  A deep  anterior  chamber  is 
evident.  The  healing  of  scleral  ruptures  is 
facilitated  by  the  proliferation  of  the  fib- 
roblasts from  the  episcleral  and  suprachor- 
oidal  tissue,  with  the  sclera  itself  inert. 

Case  50-7:  Reveals  posterior  scleral  rup- 
ture, associated  with  a soft  eye  and  marked 
hyphema.  M 


Is  autopsy  obsolete? 

The  autopsy,  the  oldest  method  of  medical  investigation,  has  been  placed 
in  a peculiar  position.  To  some  it  is  now  an  unnecessary  procedure,  one 
that  has  been  superseded  in  importance  by  newer  methods  of  study,  bio- 
chemistry, cardiac  catheterization,  angiography  and  isotope  scanning,  to 
mention  a few.  The  more  enlightened  who  hold  this  view  will  admit  that 
the  foundation  upon  which  we  draw  conclusions  from  the  newer  tests  are 
based  upon  correlations  with  autopsies.  They  argue  now  that  since  the 
anatomic  baselines  have  been  established,  we  should  "move  on"  in  the 
newer  fields. 

The  clinician  disenchanted  with  autopsies  will  complain  that  the  patholo- 
gist fails  to  give  him  concrete  answers  to  his  questions.  At  times  the  pathol- 
ogist's service  to  the  clinician  and  to  the  case  would  be  improved  were  the 
pathologist  better  oriented  as  to  the  basic  principles  of  the  disease  states 
with  which  he  works.  Pathology  is  in  a way  a facet  of  clinical  medicine 
and  the  clinically  oriented  pathologist  can  serve  better  than  the  one  who 
considers  pathology  a field  complete  unto  itself.  While  there  is  room  for 
im.provement  in  the  technique  of  the  autopsy,  there  is  no  justification  for 
el’minafon  of  it.  (Jesse  E.  Edwards.:  The  Autopsy:  Do  We  Still  Need  It? 
Chest  (Editorials)  57:2  (Feb.)  1970,  pages  113-114.) 


for  November,  1970 


525 


The  Acute  Abdomen.  By  Thomas  W.  Bots- 

ford,  M.D.  and  Richard  E.  Wilson,  M.D. 

W.  B.  Saunders  Company,  Philadelphia, 

1969. 

Drs.  Botsford  and  Wilson  have  uniquely 
organized  this  new  book,  not  by  organ  sys- 
tem or  anatomic  location  but  rather  by 
basic  pathophysiologic  processes.  In  con- 
sidering such  diseases  as  acute  appendicitis, 
acute  cholecystitis  and  acute  diverticulitis 
together  as  “Acute  Abdominal  Inflamma- 
tory Disease,”  the  unifying  concept  of  path- 
ogenesis becomes  immediately  apparent. 
Rather  than  learning  about  several  sepa- 
rate diseases,  the  reader  is  presented  with 
a common  pattern  of  disease  which  can  af- 
fect several  organs,  producing  the  identical 
signs  and  symptoms  of  the  acute  abdomen. 
This  approach  is  continued  in  the  sections 
on  abdominal  trauma,  intestinal  obstruc- 
tion, intra-abdominal  hemorrhage. 

In  a separate  section,  the  tools  used  in 
diagnosis  are  discussed.  Accurate  communi- 
cation between  the  physician  and  patient  is 
properly  stressed  but  poorly  illustrated.  For 
example,  the  authors  suggest  that,  rather 
than  ask  a patient  if  his  pain  comes  and 
goes,  the  physician  should  ask  if  the  pain 
is  colicky  or  crampy.  Unfortunately,  many 
patients  may  be  unable  to  correctly  define 
colicky  pain  and  furthermore  might  be  em- 
barrassed to  ask  for  a correct  definition. 
Similarly,  the  authors  suggest  asking  the 
patient,  “How  is  the  pain  affecting  you?” 
This  reviewer  would  be  at  a loss  to  an- 
swer this  question  and  certainly  would  not 


respond  with  statements  about  his  appe- 
tite or  bowel  movements. 

In  addition  to  the  routine  laboratory  and 
X-ray  examinations,  some  newer  and  more 
specialized  diagnostic  techniques  such  as 
angiography  and  radioactive  scanning  are 
described.  Although  the  indications  for  us- 
ing these  techniques  are  mentioned,  they 
are  not  complete.  Thus,  the  authors  sug- 
gest the  use  of  angiography  in  diagnosing 
renal  trauma  while  failing  to  mention  its 
value  in  diagnosing  fractures  of  the  liver 
or  subcapsular  splenic  injuries. 

Many  of  the  discussions  are  not  complete. 
At  times,  only  one  side  of  a controversial 
subject  is  presented.  For  example,  the  use 
of  a barium  meal  in  small  bowell  obstruc- 
tion is  described  as  a safe  procedure  which 
should  be  used  to  confirm  the  diagnosis  and 
ascertain  the  level  of  the  obstruction.  Simi- 
larly, the  only  treatment  suggested  for  right 
colon  wounds  is  the  right  hemicolectomy 
with  proximal  enterostomy.  In  some  in- 
stances, such  as  upper  gastrointestinal 
bleeding  or  large  bowel  obstruction,  treat- 
ment is  not  discussed  at  all.  While  it  is 
probably  beyond  the  scope  of  this  short 
book  to  completely  consider  treatment,  it 
is  disconcerting  to  have  treatment  discussed 
for  some  diseases  and  omitted  for  others. 

The  novel  approach  used  in  considering 
the  diseases  which  cause  an  acute  abdomen 
is  excellent.  Unfortunately,  the  authors 
have  severely  limited  their  discussions, 
omitting  important  aspects.  A lack  of 
thoroughness  seriously  detracts  from  the 
value  of  this  new  book. 

Stuart  M.  Poticha,  M.D. 


Taxes  may  outstrip  wage  increases 

Taxes  could  rise  faster  than  wage  increases  this  decade,  a Chamber  of 
Commerce  of  the  United  States  study  predicts.  A family  of  four  whose 
earnings  may  go  from  $10,000  to  $16,000  can  expect  taxes  to  double, 
largely  because  of  growing  expenditures  by  state  and  local  governments. 


526 


Illinois  Medical  Journal 


Medical 
care 
of  the 
elderly 
patient 

The  medical  care  of  the  aged  individual 
is  not  basically  different  from  medical  care 
for  adults.  There  are  however  certain 
emergencies  that  seem  to  be  more  com- 
mon among  the  aged  and  there  are  also 
some  specific  pitfalls  and  dangers  inherent 
in  dealing  with  problems  of  the  aged.  The 
elderly  patient  usually  has  a multiplicity 
of  diagnoses.  He  may  have  had  long-stand- 
ing chronic  complaints  from  all  of  these 
illnesses,  but  for  some  reason  the  balance 
is  suddenly  tipped  and  there  is  an  acute 
disruption  with  a resultant  emergency.  The 
patient  may  have  been  chronically  decom- 
pensated or  suffering  from  a chronic  bron- 
chitis but  an  acute  super-imposed  infection 
may  precipitate  a pneumonitis.  We  con- 
stantly implore  elderly  persons  to  establish 
with  their  doctors  previous  base  line  statis- 
tics for  their  physical  condition.  They 
should  have  periodic  electrocardiograms 
and  chest  X-rays,  so  that  if  there  is  some 
acute  illness  we  then  have  something  to 
compare  with  prior  conditions  and  status. 

Many  illnesses  cause  violent  symptoms 
in  younger  persons,  but  not  in  the  elderly. 
A common  example  of  this  is  with  broncho- 
pneumonia. Acute  abdominal  ailments  can 
also  be  deceiving.  Oldsters  often  do  not  feel 
the  pain  or  they  are  so  used  to  having 
chronic  pains,  they  do  not  realize  or  report 
an  acute  situation.  It  is  not  uncommon  for 
an  elderly  person  not  to  complain  about 
the  pain  of  a recent  myocardial  infarction 
for  the  same  reasons.  They  may  not  feel  the 
pain  as  much  because  over  the  years,  col- 
lateral arteries  have  developed  and  when 
one  branch  occludes,  others  take  its  place. 


By  Bertram  B.  Moss,  M.D./Chicago 


On  the  other  hand,  a person  of  any  age  will 
succumb  if  a major  artery  is  blocked.  A 
somewhat  similar  situation  exists  relative 
to  hypertension.  The  few  oldsters  who  have 
hypertension  usually  can  live  a comfortable 
but  mildly  restricted  life. 

We  have  to  be  aware  of  what  may  have 
precipitated  any  fall  which  produces  a frac- 
ture or  injury.  There  may  have  been  a 
“little  stroke”  or  just  a sudden  weakness, 
dizziness,  loss  of  sight  or  temporary  hear- 
ing, or  even  confusion,  which  resulted  in 
the  presenting  trauma.  The  emergency  may 
have  been  precipitated  by  a special  drug 
effect  or  by  an  inter-potentiation  of  many 
drugs. 

Those  who  deal  with  medical  problems 
of  the  elderly  must  be  aware  of  the  "normal 
abnormalities”  of  aged  persons.  It  is  not 
presumptive  of  diabetes  to  have  only  one 
elevated  fasting  blood  sugar  in  an  elderly 
person.  A blood  urea  nitrogen  may  be 
“normally”  elevated  in  an  elderly  person. 

Dizziness 

Elderly  people  are  particularly  prone  to 
present  with  just  “symptoms.”  One  of  the 
most  distressing  is  the  complaint  of  dizzi- 
ness. Cardiac  arrhythmias  in  elderly  persons 
can  bring  on  episodic  cerebrovascular  in- 
sufficiency. Simple  dizziness  requires  exami- 
nation of  the  eyes,  the  proprioceptive  sys- 
tem, and  the  central  nervous  system.  Whirl- 
ing vertigo  requires  examination  of  the 
ears,  eighth  nerve  and  even  brain  stem.  The 
emergency  care  of  the  patient  with  dizziness 
also  requires  that  we  rule  out  anemia. 


Bertram  B.  Moss,  M.D.,  is 
clinical  director  in  the  Divi- 
sion of  (ieronlology  at  the 
Chicago  Medical  School  and 
assistant  professor  of  medi- 
cine. Presently  medical  ad- 
ministrator at  Park  View 
Home  for  the  Aged  and  Jew- 
ish Home  for  the  Aged,  Dr. 
Moss’  specialty  is  in  the  field 
of  gerontology.  He  received 
his  M.D.  from  the  Chicago 
Medical  School  and  interned 
at  Edgewater  Hospital. 


fat  November,  1970 


527 


blood  pressure  disturbances,  and  acute 
cardiac  pathology.  Drugs  and  chemicals 
such  as  quinine,  arsenic,  mercury,  lead,  as- 
pirins, sulphonamide  and  alcohol  may  also 
produce  dizziness.  Some  cases  of  dizziness 
have  been  relieved  by  a procedure  as  simple 
as  the  removal  of  impacted  wax  in  the  ear. 
\\"e  think  of  Menieres  disease  when  the 
dizziness  is  accompanied  with  impaired 
hearing,  unbearable  nausea  and  severe 
vomiting. 

Primary  glaucoma  of  the  elderly  can  be 
a problem.  Careful  attention  should  be  paid 
to  a history  of  halos  or  recurrent  discomfort 
particularly  in  the  eye,  as  during  a movie. 
During  the  acute  congestive  glaucoma 
phase,  there  is  a severe  ocular  pain  and 
blurring  of  vision.  Nausea  and  vomiting 
may  be  so  severe,  especially  in  elderly  peo- 
ple, that  one  often  does  not  think  of  glau- 
coma and  often  mistakenly  treats  for  gastro- 
intestinal difficidty.  If  a tonometer  is  not 
immediately  available,  palpation  of  the 
eyeball  itself,  through  closed  lids,  will  usu- 
ally reveal  a very  hard  eye.  Surgery  is  usual- 
ly imminent  in  acute  glaucoma  but  prior 
to  this,  miotic  therapy,  intravenous  car- 
bonic anhydrase  inhibitors  and  hypertonic 
agents  such  as  urea  are  very  effective.  Vi- 
sion lost  from  uncontrolled  glaucoma  can 
never  be  regained.  Experience  in  the  use 
of  a tonometer  is  highly  recommended. 

Arthritis 

An  elderly  woman  presenting  with  acute 
pain  in  the  knee,  hip,  ankle,  sacroiliac  or 
subtalar  joints  should  alert  one  to  suspect 
a diagnosis  of  septic  arthritis.  This  should 
particularly  be  considered  if  an  elderly 
person  is  anemic  and  has  an  elevated  sedi- 
mentation rate.  It  should  even  be  more  sus- 
picious when  the  leading  predisposing  fac- 
tors for  bacterial  arthritis  are  present,  such 
as  the  use  of  systemic  corticosteroid  admin- 
istration, pre-existing  infection  and  diabetes 
mellitus.  Other  frequent  local  pre-disposing 
factors  are  prior  intra-articular  injection  of 
corticosteroids  and  pre-existing  joint  di- 
sease. 

Elderly  women  with  diffuse  musculo- 
skeletal pain,  but  not  detectable  changes  in 
the  muscles  and  joints,  should  make  one 
suspicious  of  polymyalgia  rheumatica.  To 
confirm  the  diagnosis,  it  is  necessary  to  have 
a high  erythrocyte  sedimentation  rate  asso- 
ciated with  an  elevation  of  alpha-globulins. 


Headaches  with  these  symptoms  should 
make  one  suspicious  for  giant  cell  arteritis. 
Irreversible  blindness  due  to  temporal  ar- 
teritis can  be  prevented  with  prompt  and 
judicious  use  of  steroids.  Don’t  forget  about 
gout  causing  a sudden  joint  pain— especial- 
ly if  the  patient  is  taking  diuretics  and 
the  pain  becomes  worse  with  use  of  aspirin. 
An  elderly  person  with  sudden  edema  may 
have  grave  implications.  Basically  all  edema 
is  renal  in  origin.  The  kidneys  reabsorb 
sodium  or  there  are  not  enough  function- 
ing nephrons  to  eliminate  sodium.  The 
Nephrotic  syndrome  produces  edema  by 
causing  hypoalbuminemia  through  renal 
protein  loss.  There  are  certain  drugs  which 
cause  edema  and  these  include  both  synthe- 
tic and  natural  conjugated  estrogens,  some 
steroids,  phenylbutazone,  oxy  phenylbuta- 
zone and  guanethidine. 

Acute  edema 

With  elderly  people  we  should  be  parti- 
ctdarly  aware  of  the  mechanism  of  genera- 
lized acute  edema.  Blood  clots,  paralysis, 
injuries  and  burns,  lymphatic  obstruction, 
allergies  and  reactions  to  heat  and  cold  can 
result  in  edema.  Lack  of  muscular  tone  in 
stroke  patients  leads  to  edema.  A patient 
may  have  pulmonary  edema  without  evi- 
dencing edema  elsewdiere.  Dyspnea,  orthop- 
nea and  nocturnal  dysuria  suggest  a cardiac 
basis  for  the  edema.  It  is  necessary  to  check 
for  the  typical  pitting  edema  due  to  hepa- 
tic, cardiovascular  and  renal  disorders. 
Edema  with  a pigskin  appearing  brawny 
picture  suggests  lymphatic  obstruction. 
Thrombophlebitis  and  pelvic  tumors  may 
produce  sudden  edema.  Easily  visible  neck 
veins  of  a jjatient  at  a 45°  angle  suggest 
cardiac  failure.  Hypertension  may  be  ab- 
sent in  idiopathic  nephrotic  syndrome  but 
present  in  acute  glomerulonephritis  with 
edema.  Emergency  laboratory  tests  will 
show  a white  count  indicating  an  inflamma- 
tory disease  or  endocarditis.  It  may  be  neces- 
sary to  do  liver  function  tests,  chest  X-rays, 
or  an  electrocardiograph.  The  central  venus 
pressure  should  be  watched  by  elevating  the 
patient’s  bed  and  noting  whether  his  neck 
veins  are  still  visible.  I doubt  whether  cen- 
tral venus  pressure  catherization  will  always 
be  necessary.  We  have  to  be  cautious  about 
diagnosing  cardiac  failure  because  a patient 
with  glomerulonephritis  may  have  increased 
venus  pressure  without  heart  failure. 


528 


Illinois  Medical  Journal 


I'he  most  serious  edema  is  the  acute  pul- 
monary edema.  Most  edemas  are  harmless 
and  the  vast  majority  of  edematous  patients 
should  not  be  hurriedly  treated  without  an 
established  diagnosis  as  to  the  cause.  But 
the  patient  with  acute  pulmonary  edema, 
must  be  treated  immediately.  This  patient 
should  be  put  into  a sitting  position.  We 
immediately  increase  the  concentration  of 
oxygen  that  the  patient  is  inspiring  (usually 
under  positive  pressure)  and  increase  the 
transfer  of  oxygen  across  the  alveolar  mem- 
brane by  adding  30%  to  50%  alcohol  to 
the  nebulizer  of  the  positive  pressure 
breathing  unit.  We  should  immediately 
digitalize  the  patient  but  remember  that 
it  may  take  several  hours  for  the  drug  to 
become  maximumly  effective.  It  may  be 
necessary  to  apply  tourniquets  to  increase 
the  venus  return  to  the  right  side  of  the 
heart  thereby  decompressing  the  pulmonary 
vascular  bed.  Some  authorities  would 
rather  do  a phlebotomy  than  apply  tourni- 
quets. After  this  is  done,  a rapid  acting 
diuretic  should  be  given  intravenously.  If 
morphine  is  given,  keep  the  dose  low,  be- 
cause the  pickup  is  slow  and  it  accumulates. 
If  the  patient  has  a bradycardia,  we  sub- 
stitute demerol  for  morphine  or  use  atro- 
pine along  with  the  morphine. 

Effects  of  digitalis 

Too  many  old  people  are  taking  digitalis 
when  they  should  not,  or  they  are  taking 
too  much  of  it.  Digitalis  has  so  many  toxic 
potentials  that  I suspect  it  would  have  a 
difficult  time  passing  FDA  regulations  to- 
day. It’s  a wonderful  drug  but  we  lack  de- 
finitive yardsticks  to  evaluate  its  dosage, 
and  the  margin  between  therapeutic  and 
toxic  doses  is  very  narrow’.  Acutely  ill  elder- 
ly patients  on  diuretics  plus  digitalis,  espe- 
cially those  with  advanced  heart  disease, 
liver  disease  or  renal  insufficiency  should 
be  considered  as  potentially  digitalis  intoxi- 
cated. Don’t  rely  on  the  usual  dosage  range. 
Be  suspicious  if  the  patient  on  digitalis  has 
anorexia.  Order  an  EKG  immediately.  Digi- 
talis intoxication  frequently  presents  with 
gastrointestinal  signs  such  as  anorexia, 
nausea,  vomiting  and  rarely  diarrhea.  Pal- 
pitations, blurred  or  yellow  vision  and  all 
kinds  of  arrhythmias  are  frequent  com- 
plaints. On  the  basis  of  suspicion  alone, 
I advise  to  stop  digitalis  and  start  potas- 
sium, orally  or  intravenously.  Dilantin, 


pronestyl,  xylocaine  or  quinidine  may  also 
be  used  in  acute  cases.  I am  not  yet 
thoroughly  convinced  about  the  usefulness 
of  Beta  adrenergic  receptor  blockers.  When 
the  patient  has  significant  AV  block,  unas- 
sociated with  atrial  tachycardia,  DON’T 
GIVE  POTASSIUM! 

A sudden  exacerbation  of  the  usual  com- 
plaint of  feeling  weak  or  fatigued  should 
be  respected.  Nearly  all  muscle  weakness 
will  respond  to  conservative  therapy.  How- 
ever, after  two  or  three  days  if  there  is  the 
beginning  of  real  diminution  of  reflexes, 
the  patient  must  be  hospitalized  and  pre- 
pared for  possible  intubation  or  tracheos- 
tomy. When  the  onset  of  weakness  is  sud- 
den, we  must  suspect  viral  infections,  func- 
tional weakness,  myasthenia  gravis,  mul- 
tiple sclerosis,  periodic  familial  paralysis 
and  diabetes,  or  sudden  loss  of  potassium. 
With  severe  headache  and  true  stiffness  of 
the  neck  we  hospitalize  the  elderly  patient 
for  a spinal  tap.  Double  vision  is  the  com- 
monest early  symptom  of  myasthenia  grav- 
is, accompanied  by  w'eakness.  Another  cause 
of  sudden  weakness  in  older  patients  is  a 
transient  ischemic  attack. 

It  is  not  uncommon  for  geriatric  patients 
to  present  with  a sore  mouth  and  dryness 
of  the  mouth  and  tongue  which  has  been 
going  on  for  some  time  but  suddenly  be- 
comes unbearable.  There  are  many  car 
of  this  distressing  condition  and  many  more 
that  are  not  so  easily  diagnosed.  Because 
of  the  dryness  the  patient  has  discomfort, 
anxiety  and  difficulty  in  swallowing.  In  the 
absence  of  specific  diagnosis  and  treatment 
a symptomatic  approach  would  be  to  rinse 
the  mouth  with  Karo  syrup  in  warm  w’ater, 
or  glycerine  and  lemon  juice  in  water  be- 
fore meals.  Salivary  secretion,  if  the  mouth 
is  found  to  be  too  dry,  can  be  stimulated 
by  physostigmine,  neostigmine  or  pilocar- 
pine. 

Elderly  people  often  present  themselves 
with  acute  pain  in  the  back  or  upper  leg. 
A common  cause  of  “sciatica”  is  protruding 
or  slipped  disc  between  the  vertebra  of  the 
low'er  back.  Excrutiating  pain  upon  move- 
ment of  a joint  could  be  due  to  a tendonitis 
or  bursitis.  The  fat  embolism  syndrome 
can  occur  in  elderly  people  usually  w'ithin 
48  hours  after  a fracture.  The  clinical  signs 
associated  with  the  fat  embolism  syndrome 
are  an  elevation  of  temperature,  a tachy- 


for  November,  1970 


529 


cardia  and  a rapid  respiratory  rate.  There 
could  also  be  an  extensor  posturing  and 
decerebrate  rigidity.  Petechiae  are  often 
visible.  If  the  diagnosis  is  suspected,  serial 
examinations  for  fat  in  the  urine  and  ser- 
ium  lipase  should  be  done  immediately.  A 
chest  X-ray  may  demonstrate  the  typical 
“snow  storm  appearance.” 

Patients  coming  to  the  emergency  room 
with  the  suspicion  of  a stroke  should  be 
hospitalized.  It  is  particularly  important  to 
determine  whether  the  manifestations  that 
appear  are  due  to  a carotid  circulatory  in- 
sufficiency or  a vertebrobasilar  insufficiency. 

If  the  diagnosis  of  an  elderly  person’s 
bizzare  complaints  or  behavior  is  not  clear, 
all  efforts  should  be  made  to  determine 
what  drugs  and  what  amount  of  drugs  are 
used.  The  incidence  of  adverse  reactions 
when  patients  take  fewer  that  five  drugs  is 
approximately  5%.  When  patients  are 


given  20  or  more  drugs,  the  incidence  of 
adverse  reaction  rises  to  45%.  The  average 
hospitalized  patient  receives  14  drugs  dur- 
ing his  hospital  stay.  One  of  the  most  bi- 
zarre manifestations  is  the  hypertensive  syn- 
pathomimetic  crisis  in  individuals  who  have 
eaten  cheese  while  on  monoamine  oxidase 
inhibitors.  One  of  the  most  common  drug 
inter-actions  among  older  people  is  that  be- 
tween digitalis  and  thiazides,  or  other  drugs 
likely  to  cause  potassium  depletion.  In  the 
presence  of  hypokalemia,  digitalis  may  pro- 
duce cardia  arythmias  which  greatly  impede 
the  control  of  digitalization.  Parallel  prob- 
lems have  also  been  observed  in  patients 
with  gout  with  salicylate  inhibition  of  the 
uricosuric  effects  of  probenecid  sulfinpyra- 
zone. 

Large  amounts  of  licorice  may  also  bring 
about  potassium  depletion  especially  if  the 
patient  is  taking  a thiazide.  ◄ 


''Mr.  Active  Member"  profile 
Proves  value  of  belonging 

As  veteran  members  realize,  participating  in  association  work  and 
programs  is  a road  to  individual  growth.  Every  responsibility  accepted  and 
discharged  increases  a man's  stature  and  his  ability  to  handle  bigger  and 
bigger  assignments.  This  accords  with  the  formula,  "Belonging  -f  Partici- 
pation = Success" 

Of  course,  it  involves  more  than  just  "going  through  the  chairs."  As  a 
member  climbs  the  ladder  of  organization  affairs,  he  broadens  his  horizon, 
practices  teamwork,  masters  communication  and  creates  a circle  of  life- 
long friends. 

Do  you  question  this?  Then  look  around  you  at  your  next  convention. 
Study  the  members  you  most  respect,  and  you  will  note  some  characteristics 
they  have  in  common.  Put  those  together,  and  you  have  a "profile"  or 
conglomerate  image  of  Mr.  Active  Member.  He  is: 

• Friendly  and  easy  to  be  with,  any  time  of  day  or  evening,  from  break- 
fast through  the  banquet. 

• Composed,  relaxed,  never  bothered  over  trifles. 

• As  interested  in  what  you  say  as  he  is  in  what  he  has  to  tell  you. 

• Generous  with  praise  for  others'  accomplishments,  silent  or  understand- 
ing about  their  failures  or  faults. 

• Stimulating  in  his  grasp  of  association  and  industry  problems  and 
potentials. 

• Innovative:  receptive  to  new  ideas,  suggestions  and  approaches. 

• Always  ready  to  help. 

The  happiest  thing  about  this  profile  is  that  it  fits  so  many  members— 
both  reason  and  proof  of  your  success  as  an  association. 


530 


Illinois  Medical  Journal 


>> 

a 

GOOD 

O ? 
C nJ 

C 

O 

&£ 

*s 

a 

SAMARITAN 

C B 

S 

4> 

!2 

LAWS 

u ‘C 
« n 

V S 

V 

^ e 

*K 

■a 

a 

o 

■I  1 w 

o'" 

(/) 

ll 

><a 

at  u 
!5 

U o 

Covei 

only 

u 


Alabama 

1966 

• 

• 

• 

• 1 • 

Alaska 

1967 

• 

• 

o 1 • 

Arizona 

1967 

• 

• 

• 

• • 

Arkansas 

1963 

• 

• 

• 1 • 

California 

1959 

• 

• 

• 

• 

Colorado 

1965 

• 

• 

• 

• 

Connecticut 

1963 

• 

• 

• 

• 1 • 

Delaware 

1963 

• 

• 

• 

Dist.  of  Columbia 

1966 

• 

• 

• 

Florida 

1965 

• 

• 

• 

• 

Georgia 

1962 

• 

• 

• 

Hawaii 

Idaho 

1965 

• 

• 

• 

• 

Illinois 

1965 

• 

• 

• 

• 

Indiana 

1963 

• 

• 

• 

Iowa 

Kansas 

1965 

• 

• 

• 

• 

• 

Kentucky 

Louisiana 

1964 

• 

• 

• 

• 

• 

Maine 

1961 

• 

• 

• 

Maryland 

1963 

• 

• 

• 

• 

Massachusetts 

1962 

• 

• 

• 

Michigan 

1963 

• 

• 

• 

• 

Minnesota 

Mississippi 

1962 

• 

• 

• 

Missouri 

Montana 

1963 

• 

• 

• 

• 

Nebraska 

1961 

• 

• 

• 

• 

Nevada 

1963 

• 

• 

e 

• 

• 

New  Hampshire 

1963 

• 

• 

• 

• 

New  Jersey 

1963 

• 

• 

• 

• 

New  Mexico 

1963 

• 

• 

• 

• 

New  York 

1964 

• 

• 

• 

• 

North  Carolina 

1965 

• 

• 

• 

North  Dakota 

1961 

• 

• 

• 

Ohio 

1963 

• 

• 

• 

• 

Oklahoma 

1963 

• 

• 

• 

• 

Oregon 

1967 

• 

• 

• 

• 

Pennsylvania 

1963 

• 

• 

• 

Rhode  Island 

1963 

• 

• 

• 

• 

South  Carolina 

1964 

• 

• 

• 

• 

South  Dakota 

1961 

• 

• 

• 

Tennessee 

1963 

• 

• 

• 

• 

Texas 

1961 

• 

• 

• 

• 

Utah 

1961 

o 

• 

• 

Vermont 

Virginia 

1962 

• 

• 

Washington 

West  Virginia 

1967 

• 

• - 

• 

• 

Wisconsin 

1963 

• 

• 

• 

Wyoming 

1961 

• 

• 

• 

• 

TOTAL 

39 

5 

2 

12 

26 

16 

43 

25 

Reprinted  from  Resident  and  Staff  Physician,  March,  1970. 


/or  November,  1970 


531 


By  Frank  M.  Pfeifer,  Counsel,  ISMS/Springfield 


Supreme  Court  decision 

in 

Hepatitis  case 


On  September  29,  1970  the  Illinois  Supreme 
Court  handed  down  a decision  in  the  case  of 
Cunningham  vs.  MacNeal  Me^norial  Hospital, 
holding  that  the  hospital  was  liable  in  damages 
to  a patient  alleged  to  have  contracted  hepatitis 
from  a blood  transfusion. 

Mrs.  Cunningham  received  a blood  transfusion 
while  in  the  hospital  and  later  came  down  with 
hepatitis,  which  the  suit  alleges  was  caused  by 
the  blood  used  in  the  transfusion.  The  hospital 
defended  upon  the  grounds  that  a blood  trans- 
fusion is  a service  rather  than  a product  and 
therefore,  the  strict  liability  or  product  warranty 
theory  should  not  apply. 

The  Supreme  Court  held  the  fact  that  there 
is  no  definite  scientific  test  for  hepatitis  makes 
no  difference,  as  there  is  an  implied  warranty  that 
the  blood  so  used  is  free  from  any  impurities. 

While  the  hospital  was  the  only  one  sued  in 
this  case  the  decision  would  indicate  that  the 
physician  involved,  as  well  as  the  blood  donor, 
and  all  persons,  firms  or  corporations  in  any  way 
handling  or  processing  the  blood  would  also  be 
liable,  if  sued. 

The  ramifications  of  the  decision  are  many 
and  the  result  is  a great  setback  for  medicine.  All 
persons  involved  in  the  handling  of  blood,  in- 
cluding the  physicians  and  hospitals,  are  subject 
to  suit,  insurance  premiums  will  necessarily  in- 
crease, some  physicians  may  refuse  to  perform 
transfusions,  many  blood  donors  will  be  afraid 
to  give  blood,  and  some  blood  banks  may  elimi- 
nate this  service. 

Anticipating  the  possibility  of  such  a decision. 


House  Bill  616  was  introduced  at  the  1969  ses- 
sion of  the  legislature,  which  would  have  declared 
blood,  corneas,  bones  and  other  organs  or  human 
tissues,  when  transfused  or  transplanted,  to  be  a 
service  rather  than  a product.  The  bill  unfor- 
tunately, did  not  pass.  This  bill  specifically  pro- 
vided that  no  warranty  of  any  kind  attached  to 
such  items  and  that  persons  handling  them 
w'oidd  not  be  liable  for  any  impurities  contained 
therein.  The  Illinois  State  Medical  Society  and 
the  Illinois  Hospital  Association  will  cause 
to  be  reintroduced,  in  the  1971  session  of  the 
legislature,  a bill  similar  to  House  Bill  616,  and 
will  attempt  to  obtain  all  possible  support  for 
its  passage. 

While  no  one  can  say  with  absolute  certainty 
that  a written  consent  form,  in  which  the  pa- 
tient requests  the  blood  and  consents  to  the  pro- 
cedure, will  constitute  a defense,  such  a consent 
shoidd  be  used  in  all  cases,  for  there  is  a good 
chance  that  the  Courts  would  uphold.  Follow- 
ing is  a suggested  joint  consent  which  could  be 
used  by  physicians  and  hospitals,  which  hopefully 
would  cover  everyone  associated  with  the  blood 
and  its  use.  It  is  to  be  noted  that  the  form  is 
to  be  signed  by  the  patient  in  the  presence  of  a 
Notary  Public.  The  notarization  is  not  a specific 
legal  requirement  but  it  is  felt  that  by  so  doing, 
more  authority  is  added  to  the  form,  that  the 
patient  or  his  heirs  would  have  difficulty  in  stat- 
ing that  the  consent  was  not  voluntary  and  there- 
fore its  chances  of  being  accepted  by  the  Court 
shoidd  be  enhanced.  If  the  attestation  of  the 
Notary  Public  is  not  used,  it  should  be  deleted 
from  the  form. 


532 


Illinois  Medical  Journal 


REQUEST  FOR  TRAI\SFUSIOIS  OF 
WHOLE  BLOOD  OR  ANY  OF  ITS 
COMPONENTS 


1,  , do  hereby  request  Dr and  any  of  his  assist- 

(Attending  Physician) 

ants  or  associates  (hereinafter  called  physician)  to  administer  to  me  such  blood  transfusions  or  any 
blood  components  including,  but  not  limited  to,  plasma,  as  may  be  deemed  advisable  in  the  judge- 
ment of  any  such  physician. 

It  has  been  explained  to  me  that  it  is  not  always  possible  to  detect  the  existence  or  non-exist- 
ence of  some  elements  occasionally  present  in  blood  such  as  the  virus  causing  infectious  hepatitis 
or  other  unusual  blood  components  and  that  there  is  a possibility  of  ill  effects,  such  as  Infectious 
Hepatitis  resulting  from  the  transmission  of  its  virus  or  a transfusion  reaction  resulting  from  the 
transmission  of  unusual  blood  components.  I also  understand  that  there  is  the  possiljility  of  the 
transmission  of  the  causative  agent  of  other  diseases. 

It  has  also  been  explained  to  me  that  emergencies  may  arise  when  it  is  not  possible  to  make 
adequate  cross-matching  or  other  tests  and  that  immediate  need  may  make  it  necessary  to  use  exist- 
ing stocks  of  blood  which  may  include  some  incompatible  blood  types  or  substances. 

It  is  understood  and  expressly  agreed  that  the  blood  supplied  in  accordance  with  this  agreement 
is  incidental  to  the  rendition  of  services  and  that  no  requirements,  guarantee  or  warranty  of  fit- 
ness, quality  or  absence  of  undectable  substances  such  as  viruses  shall  apply. 

After  considering  all  of  the  items  set  forth  above  and  the  possibility  of  adverse  results  from 
the  said  blood  transfusions,  it  is  still  my  desire  that  one  or  more  transfusions  of  blood  or  its  com- 
ponents be  administered  to  me,  if  in  the  opinion  of  my  physician  such  transfusions  are  needed. 

I hereby  assume  any  and  all  risks  in  connection  with  any  said  blood  transfusions  and  re- 
lease physician  and  Hospital  of  , Illinois,  its  per- 

sonnel and  employees,  all  blood  donors  and  all  other  persons,  firms  and  corporations  which  in  any 
way  handled  or  processed  said  blood,  from  any  responsibility  whatsoever  for  any  resulting  contrac- 
tion of  viral  hepatitis  or  any  reaction  from  any  such  transfusion. 

I further  assume  any  and  all  risks  in  connection  with  said  blood  transfusions  and  agree  that  I will 
never  bring  suit  in  connection  with  said  transfusions. 

IN  WITNESS  WHEREOF  I have  hereunto  set  my  hand  and  seal  at  M.  on  this  the 

day  of  , A.D.  19 


STATE  OF  ILLINOIS  ) 

) SS 

COUNTY  OF  ) 


(SEAL) 


I a Notary  Public  in  and  for  said  County  in  the  State  aforesaid,  do 

hereby  certify  that  personallv  known  to  me  to  be  the  same  person  whose 

name  is  subscribed  to  the  foregoing  instrument,  appeared  before  me  this  day  in  person,  and  acknowl- 
edged that  he  signed,  sealed  and  delivered  the  said  instrument  as  his  free  and  voluntary 


act  for  the  uses  and  purposes  therein  set  forth. 

GIVEN  under  my  hand  and  notarial  seal  this  day  of  , A.D.  19. 

Notary  Public 


University  of  California  offers  Master  of  Public  Health  degree 


The  Division  of  Maternal  and  Child 
Health  of  the  University  of  California 
School  of  Public  Health  at  Berkeley  an- 
I '.ounces  postgraduate  programs  leading  to 
the  degiee  of  Master  of  Public  Health. 
These  programs  are  for  pediatricians,  ob- 
stetricians, and  other  physicians  interested 
in  receiving  training  in  the  field  of  Mater- 
nal and  Child  Health.  Fellowship  support 
is  available,  including  basic  support  for  the 
trainee,  an  allowance  for  dependents,  tui- 
tion and  fees. 

Program  areas  now  available  include 
nine-month  programs  in  Maternal  and 


Child  Health,  Health  of  School-Age  Chil- 
dren, and  Maternal  Health  and  Family 
Planning.  A twenty-one  month  program  in 
Care  of  Handicapped  Children,  Perinatol- 
ogy, and  Comprehensive  Care  is  available. 
There  are  also  three-year  Career  Develop- 
ment Programs  in  Pediatrics  and  Obstetrics 
which  combine  Public  Health  and  Resi- 
dency training.  Fellowships  are  available 
for  these  progiams  also. 

Applications  are  now  being  accepted  for 
the  group  entering  September,  1971.  For  in- 
formation, write  to  Helen  M.  Wallace, 
M.D.,  School  of  Public  Health,  University 
of  California,  Berkeley,  California  94720. 


for  November,  1910 


53.S 


NEW 

PHARMACEUTICAL 

SPECIALTIES 

by  Paul  deHaen 


For  detailed  information  regarding  indica- 
tions, dosage,  contraindications,  and  adverse 
reactions,  refer  to  the  manufacturer’s  package 
insert  or  brochure. 

Single  Chemicals:  Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products:  Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products:  Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms:  Of  a previously  introduced 
product. 

'The  following  new  drugs  have  been  marketed: 

NEW  SINGLE  CHEMICAL 

PERGONAL  Fertility  Agent  R 

Manufacturer:  Cutter 
Nonproprietary  Name:  Menotropins 
Indication:  Induction  of  ovulation  and  pregnancy 
in  the  anovulatory  infertile  patient  in  whom 
the  cause  of  anovulation  is  secondary  and  not 
due  to  primary  ovarian  failure. 
Contraindications:  A high  level  of  urinary  gona- 
dotropin. Overt  thvroid  and  adrenal  dysfunc- 
tion. Organic  intracranial  lesion.  Any  cause  of 
infertility  other  than  anovulation  as  stated  in 
indications.  Abnormal  bleeding  of  undetermin- 
ed origin.  Ovarian  cysts  or  enlargement  not 
due  to  polycystic  ovary  syndrome.  Pregnancy. 
Dosage:  Must  be  individualized.  Initial  dose 
should  be  75  I.U.  of  FSH  and  75  I.U.  of  LH 
(one  ampule)  per  day,  i.m.  for  9 to  12  days 
followed  by  10,000  I.U.  of  human  chorionic 
gonadotropin  (HCG)  one  day  after  last  dose 
of  PERGONAL. 

Supplied:  Ampuls 

DUPLICATE  SINGLE  PRODUCTS 
FLUOROPLEX, 

Topical  Solution  Cancer  Chemotherapy  R 

"'Manufacturer:  Herbert,  Div.  Allergan 
Nonproprietary  Name:  Fluorouracil 
M'^dications:  Multiple  actinic  (solar)  keratoses 
Fontraindications:  Hypersensitivity  to  component 
Dosage:  Apply  twice  daily  with  sufficient  solu- 
tion to  cover  lesion.  Continue  medication  tm- 
til  inflammatory  reaction  reaches  the  erosion, 
necrosis  and  ulceration  stage. 

Sunnlied:  Solution,  1%  in  30  cc  dropper  bottle 
HIPPUTOPE  Diagnostic-Organ  Function  R 

Manufacturer:  Squibb 

Nonproprietary  Name:  Sodium  lodohippurate 

I 131 

Indications:  Appraisal  of  individual  kidney  func- 
tion 


Contraindications:  Should  not  be  administered 
to  women  who  are  or  may  become  pregnant, 
or  during  lactation  unless  need  for  agent  out- 
weighs potential  risk  from  radiation. 

Dosage:  (jeneral  range:  i.v.  5-25  /xCi,  do  not 
exceed. 

Supplied:  Multidose  vials,  0. 5-5.0  ^tCi 

COMBINATION  PRODUCTS 

BIAVAX  Biological  R 

Manufacturer:  Merck  Sharp  & Dohme 
Composition:  Live  rubella  virus  vaccine,  HPV-77 
strain  Mumps  vaccine,  Jeryl  Lynn  virus  strain 
Indications:  Simultaneous  immunization  against 
rubella  and  mumps 

Contraindications:  Pregnancy  or  possibility  of 
pregnancy  within  three  months  after  vaccina- 
tion. Routine  immunization  of  adolescent  and 
adult  women.  Persons  in  whom  either  of  the 
component  vaccines  is  contraindicated.  Sensi- 
tivity to  chicken,  duck,  chicken  or  duck  eggs 
or  feathers  or  neomycin.  FebrOe  respiratory 
illness  or  active  febrile  infections,  blood  dys- 
crasias,  leukemia,  lymphomas  or  malignant  neo- 
plasms affecting  bone  marrow  or  lymphatic 
system.  Gamma  globulin  deficiency,  or  con- 
comitant therapy  with  ACTH,  corticosteroids, 
irradiation,  alkylating  agents  or  antimeta- 
bolites. 

Dosage:  Single  injection 
Supplied:  Vials,  single  dose 

DUOHALER  Bronchodilator  R 

Manufacturer:  Riker  Laboratories 
Composition:  Each  measured  dose  contains: 
Isoproterenol  HCl  0.16  mg. 

(Equivalent  to  0.137  mg.  isoproterenol  base) 
Phenylephrine  bitartrate  024  mg. 

(Ekjuivalent  to  0.126  mg.  phenylephrine  base) 
Indications:  Relief  of  dyspnea  resulting  from 
bronchospasm,  congestion  and  edema  of  the 
tracheobronchial  tree. 

Contraindications:  Hypersensitivity  to  either 

agent.  Pre-existing  cardiac  arrhythmias  asso- 
ciated with  tachycardia. 

Dosage:  1 to  2 inhalations  4 to  6 times  daily. 
Supplied:  Aerosol  instrument 

RENOTEC  Diagnostic-Organ  Function  R 

Manufacturer:  Squibb 

Composition:  Technetium^s™  complexed  with 

Chelating  agent  DTPA  (Diethylene  Triamine 
Pentacetic  Acid) 

Indications:  Kidney  Scanning 
Contraindications:  None  mentioned 
Dosage:  i.v.,  one  unit  dose 
Supplied:  Kit  of  five  unit  doses 

NEW  DOSAGE  FORM 

TESLAC  Cancer  Chemotherapy  R 

Manufacturer:  Squibb 
Nonproprietary  Name:  Testolactone 
Indications:  Palliative  treatment  of  advanced  or 
disseminated  breast  cancer  in  post  menopausal 
women. 

Contraindications:  Breast  cancer  in  men 
Dosage:  One  tablet  t.i.d. 

Supplied:  Tablets,  50  mg. 


You  Need  to  Keep  Moving 

"Business  is  like  riding  a bicycle— either  you  keep  moving  or  you  fall 
down."  Anonymous 


534 


Illinois  Medical  Journal 


Mead  Johnson  Labs  to  sponsor 
Program  on  cancer  chemotherapy 

Mead  Johnson  Laboratories  will  sponsor  a Cancer  Chemotherapy  Pro- 
gram in  1971.  The  program  will  consist  of  lectures  to  be  given  by  out- 
standing medical  authorities  in  the  field  of  cancer  chemotherapy.  Four- 
teen M.D.’s,  all  with  hospital,  university  or  clinic  affiliations  will  deliver 
the  lectures. 

Medical  organizations  interested  in  obtaining  one  of  the  speakers  should 
contact: 

Martin  E.  Vancil,  M.D. 

Associate  Director 
Medical  Research  Department 
Mead  Johnson  8c  Company 
Evansville,  Indiana  47721. 

Mead  Johnson  Laboratories  will  make  arrangements  for  speaker  pro- 
curement and  will  defray  expenses  for  honoraria,  travel  and  lodging. 


Efudex  by  Roche  available  for  solar  keratoses  treatment 


A new  approach  to  the  treatment  of  solar 
keratoses  is  now  available  in  the  form  of 
a topical  agent,  Efudex  (fluorouracil), 
which  has  just  been  introduced  by  Roche 
Laboratories,  division  of  Hoffmann-La 
Roche  Inc. 

Efudex  (fluorouracil)  is  useful  for  the 
topical  treatment  of  multiple  actinic  or 
solar  keratoses.  This  has  been  demonstrated 
in  clinical  studies  covering  727  patients. 
The  active  ingredient  of  Efudex  is  5-fluo- 
rouracil,  a fluorinated  pyrimidine  which  is 
an  antineoplastic  antimetabolite.  While 
fluorouracil  affects  cell  growth  and  division 
of  all  cells,  its  effect  is  most  marked  on  those 
cells  which  grow  more  rapidly  and  which 
therefore  take  up  the  drug  at  a more  rapid 
pace. 


Efudex  is  available  in  both  topical  solu- 
tion and  as  a cream;  Efudex  solution  con- 
tains either  2%  or  5%  of  fluorouracil  on  a 
weight/weight  basis,  compounded  with  pro- 
pylene glycol,  tris  (hydroxymethyl)  amino- 
methane,  hydroxypropyl  cellulose,  parabens 
(methyl  and  propyl)  and  disodium  edetate. 

Efudex  cream  contains  5%  fluorouracil 
in  a vanishing  cream  base  consisting  of  white 
petrolatum,  stearyl  alcohol,  propylene  gly- 
col, polysorbate  60,  and  parabens  (methyl 
and  propyl). 

For  contraindications,  warnings,  precau- 
tions, and  adverse  reactions,  dosage  and  ad- 
ministration, the  attached  package  insert 
should  be  consulted. 


Attendance:  Prescription  for 
Improving  perspective 

There  weren^t  many  conventions  in  the  Fifteenth  Century, 
but  Leonardo  Da  Vinci  said  something  that  applies  directly 
to  those  we  hold  today.  The  immortal  who  gave  us 
Mona  Lisa  and  The  Last  Supper  counseled  a contemporary: 

"Every  now  and  then,  go  away  and  have  a little  re- 
laxation. When  you  come  back  to  your  work,  your  judg- 
ment will  be  surer.  But  to  remain  constantly  at  work  will 
cause  you  to  lose  power  of  judgment. 

"Go  some  distance  away,  because  then  the  work  appears 
smaller.  More  of  it  can  be  taken  in  at  a glance,  and  lack 
of  harmony  or  proportion  more  readily  seen." 


for  November,  1970 


535 


Two  years  ago,  Dr.  Philip  Thomsen,  then 
president  of  ISMS,  made  national  headlines 
by  accusing  his  alma  mater,  the  Univer- 
sity of  Illinois,  of  de-emphasizing  the  fam- 
ily practice  of  medicine  and  of  not  produc- 
ing enough  physicians  of  any  kind.  His 
pungent  comments  resulted  in  his  own 
school— and  most  others  as  well— taking 
steps  to  increase  their  enrollments  and  re- 
vising their  medical  curriculae  to  educate 
more  family  practitioners. 

For  many  years  ISMS  has  been  aware 
that  fewer  and  fewer  physicians  have  been 
going  into  general  practice.  Pleas  for  a phy- 
sician have  been  heard  from  the  smaller 
towns  throughout  the  state,  and  many  de- 
vices have  been  employed  to  encourage  one 
to  settle  in  a rural  area.  These  measures  in- 
cluded guarantees  of  money  while  going 


ISMS  thought  it  advisable  to  try  to  find  out 
what  the  5,000  students,  interns  and  resi- 
dents who  now  are  in  training  in  Illinois 
plan  to  do.  Early  last  spring,  questionnaires 
were  sent  to  5,000  students;  1,396  or  28  per- 
cent were  returned. 

The  first  question  asked  was  “Is  your 
home  in  Illinois?” 


591  Students 


Yes 

No 

No  ansv 

392 

184 

18 

(66%) 

(31%) 
252  Interns 

(3%) 

156 

88 

8 

(61.5%) 

(35%) 

550  Residents 

(3%) 

398 

133 

19 

(72.3%) 

(24%) 

(3%) 

The  plans  of  our  doctors 

In  training 


First  Article 


Bs  J.  Ernest  Breed/Chicago,  ISMS  president 


to  school— providing  the  young  doctor 
would  come  back  to  practice— provision  of 
a very  hne  office  free  of  charge,  guarantees 
of  income,  etc. 

Only  about  30%  of  those  we  educate 
stay  in  the  state,  and  of  these  only  about 
one-third  go  outside  Cook  County  to 
practice.  Last  year  still  greater  efforts 
were  made  to  encourage  young  doctors  to 
stay  in  Illinois  and  to  practice  outside  Cook 
County.  Still,  the  demands  for  doctors  con- 
tinue to  increase,  while  demands  for  con- 
trols over  the  distribution  of  physicians 
from  people  outside  the  profession  become 
louder. 

Realizing  that  another  5 to  10  years 
will  pass  before  the  increase  in  medical  stu- 
dents will  materially  increase  the  number 
of  physicians  looking  for  a place  to  practice, 


It  is  surprising  that  so  large  a percentage 
(66%)  of  our  students  come  from  Illinois, 
since  only  one  of  the  five  medical  schools 
is  a state  school  to  which  state  residents  pay 
a lower  tuition.  It  is  reasonable  that  a 
higher  percentage  (72.3%)  of  residents 
come  from  this  state  since  many  plan  to 
practice  in  their  home  state  and  it  is  usual 
for  a young  doctor  to  take  his  residency  in 
the  state  in  which  he  plans  to  practice. 

“Do  you  plan  to;  (A)  practice  medicine, 
(B)  do  medical  research  (C)  confine  your 
efforts  to  teaching?” 


591  Students 

y-s 

No 

Undecided 

(A) 

4 

34 

(9  5%) 

(1%) 

(5%) 

(B) 

105 

(18%) 

183 

306 

(C) 

55 

(9.25%) 

220 

319 

536 


Illinois  Medical  Journal 


Since  these  figures  add  up  to  over  100%, 
it  is  obvious  that  at  the  student  level,  inde- 
cision is  prevalent.  However,  it  does  indi- 
cate that  many  plan  to  do  other  than  attend 
sick  people. 

The  corresponding  questions  and  answers 
received  from  252  residents,  were  193 
(76%)  yes,  6 (2.3%)  answered  no,  and  an- 
other 53  did  not  answer  the  question. 

Five  hundred  and  fifty  residents  answered 
the  question  as  follows:  practice  medicine 
480  (87.2%),  do  medical  research,  130 

(23.5%),  confine  efforts  to  teaching  134 
(24.3%). 

I’hese  rejilies  are  difficult  to  assess.  They 
do  disclose  that  the  further  students  go 
along  in  their  training,  a greater  percent 
plan  to  go  into  teaching  or  research  and 
fewer  plan  to  practice  nredicine;  93.5%  of 
students  plan  to  practice,  87.2%  of  resi- 
dents; 9.25%  of  students  plan  to  confine 
their  efforts  to  teaching  while  24.3%  of 
residents  state  this  as  their  plan. 

When  one  realizes  that  many  physicians 
practice  for  a time,  then  take  administra- 
tive jobs  in  industry,  hospitals  or  other  or- 
ganizations, it  becomes  obvious  these  phy.si- 
cians  along  with  those  who  plan  to  do  re- 
search and  teach,  will  be  lost  to  society  as 
“practicing  physicians.” 

The  next  question  concerns  the  place  of 
practice  and  was  answered  as  follows: 


594  Students 


Yes 

No 

No  answer 

Do  you  plan 
to  practice  in 

153 

351 

90 

Illinois? 

(25.76%) 

(59%) 

(15.1%) 

Do  you  plan 
to  practice  in 

89 

Chicago? 

(58.1%) 

Do  you  plan 
to  practice 

66 

elsewhere? 

(43%) 

252  Interns 

Do  you  plan 
to  practice  in 

77 

77 

98 

Illinois? 

(30.5%) 

(30.5%) 

(38.8%) 

Do  you  plan 
to  practice  in 

57 

Chicago? 

(74%) 

Do  you  plan 
to  practice 

20 

elsewhere? 

(26%) 

550  Residents 

Do  you  plan 
to  practice  in 
Illinois? 

222 

(40.3%) 

182 

Do  you  plan 

to  practice  in 

143 

104 

Chicago? 

Do  you  plan 

(26%) 

to  practice 

80 

elsewhere? 

(36.5%) 

It  is  disheartening  to  find  that  only 
25.75%  of  students,  30.5%  of  interns  and 
40.3%  of  residents  plan  to  practice  in  Illi- 
nois. Since  the  student  frecpiently  takes  his 
internship  and  residency  in  the  state  in 
which  he  plans  to  practice,  it  is  rea.sonable 
to  see  the  increased  percentages  in  these 
groups.  It  is  still  more  distressing  to  learn 
that  only  43%  of  students,  26%  of  interns 
and  36.5%  of  the  residents  who  plan  to 
stay  in  Illinois  are  going  to  practice  medi- 
cine outside  of  Cook  County. 

Saying  it  another  way,  of  594  students, 
only  66  or  11%  have  decided  to  practice 
in  Illinois,  outside  of  Cook  County;  8%  of 
252  interns  and  14%  of  550  residents  have 
made  the  same  decision. 

The  medical  profession  is  responsible  for 
the  health  care  of  the  people.  ISMS  must 
assume  leadership  in  providing  care  for  all 
the  people  who  live  in  Illinois.  There  are 
two  areas  in  which  medical  care  is  badly 
needed— the  ghettos  of  the  cities  and  the 
rural  areas.  Because  of  the  many  non-medi- 
cal difficulties  encountered  in  providing 
ghetto  residents  with  medical  care,  many 
groups  beside  the  medical  society  are  help- 
ing. Unfortunately,  there  is  little  coordina- 
tion between  the  different  groups,  which 
include  the  federal  government,  the  city 
government,  and  the  different  medical 
schools,  different  hospitals  and  community 
groups.  ISMS  and  the  Chicago  Medical  So- 
ciety assist  all  of  these  groups  working  in 
the  city  ghettos  as  much  as  possible. 

Since  outside  of  Cook  County  there  is 
little  effort  by  other  organizations  to  sup- 
ply medical  care  to  areas  of  great  medical 
need,  ISMS,  with  little  success,  has  at- 
tempted to  encourage  young  doctors  to 
practice  outside  Cook  County.  It  appears 
from  our  survey  results  that  the  young  doc- 
tors now  in  training  in  Illinois  will  follow 
the  same  pattern  as  their  recent  predeces- 
sors. For  this  reason,  we  are  fostering  new 
systems  of  medical  practice  that  are  de- 
signed to  attract  the  young  specialists  into 
towns  and  smaller  cities  of  the  state. 

The  second  article  based  on  the  ques- 
tionnaire sent  to  the  students,  interns  and 
residents  will  be  published  next  month,  dis- 
closing the  type  of  practice  the  young  doc- 
tors are  planning  to  embrace.  With  this  in- 
formation, we  are  in  a better  position  to  at- 
tract young  doctors  to  areas  outside  the 
large  cities.  ◄! 


for  November,  1970 


537 


Editorial  Board 

Frederick  Steigman,  M.D.,  Chicago,  Chairman 
Gastroenterology 
Edward  DuVivier,  M.D.,  Alton 
Pediatrics 

Arthur  DeBoer,  M.D.,  Chicago 
Cardiac  Surgeon 

Donald  L.  Unger,  M.D.,  Des  Plaines 
Allergy 

Joseph  H.  Kiefer,  M.D.,  Chicago 
Urology 

Clarence  J.  Mueller,  M.D.,  Sterling 
General  Surgery 
Robert  E.  Lane,  M.D.,  Chicago 
Ob-Gyn 

David  Shoch,  M.D.,  Chicago 
Ophthalmology 

Ernest  Lowenstein,  M.D.,  Mt.  Carmel 
Family  Practice 
Newton  DuPuy,  M.D.,  Quincy 
Ob-Gyn 

Thomas  J.  Collins,  M.D.,  Chicago 
Pathology 

Arkell  M.  Vaughn,  M.D.,  Chicago 
Surgery 

William  E.  Adams,  M.D.,  Chicago 
Surgery 

L.  Martin  Hardy,  M.D.,  Chicago 
Pediatrics 

Edward  Cruzat,  M.D.,  Chicago 
Genera!  Surgery 

Neil  Allen,  M.D.,  Morton  Grove 

Resident  in  Neurology  and  Surgery 
Contributor  in  Surgery 

John  M.  Beal,  Chicago 
Contributor  in  Radiology 

Leon  Love,  M.D.,  Maywood 
Contributor  in  Cardiology 

John  R.  Tobin,  M.D.,  Maywood 
Contributor  in  Medical  Progress 
Harvey  Kravitz,  M.D.,  Skokie 
Editor:  Theodore  R.  VanDellen,  M.D. 


Publications  Committee 


Board  of  Trustees 

Jacob  E.  Reisch,  M.D.,  Springfield,  Chairman 
A.  E.  Livingston,  M.D.,  Bloomington 
Warren  W.  Young,  M.D.,  Chicago 


Crash  program  needed  for  family  doctors 


“To  Avert  Family  Doctor  Shortage,  HEW 
To  Take  Over  All  Medical  Schools.”  Such 
a headline  could  aj^pear  tomorrow,  but  with 
foresight,  we  may  never  need  a crash  pro- 
gram to  abort  such  a takeover.  U.S.  medi- 
cine’s usual  “too  little,  too  late”  may  find 
us  in  just  such  a spot.  There  are  groups 
that  would  like  to  take  over  American  medi- 
cine; recently.  Senator  Edward  M.  Ken- 
nedy (D.  Mass.)  announced  his  plan. 

But  what  sort  of  crash  program  could  pro- 
duce the  needed  family  doctor?  A seem- 
ingly simple  solution  would  be  to  require 
every  graduate  of  the  next  senior  class  to 
go  into  general  practice  for  two  years,  thus 
the  shortage  could  be  solved  in  a matter 
of  months.  This  could  produce  a shortage 
of  specialists  two  years  hence,  but  I doubt 
it,  for  by  then,  the  medical  schools  could 
have  had  time  to  increase  their  enrollment. 
Also,  the  political  pressure  would  be  off 
soon  after  the  family  doctor  shortage  was 
relieved  and  we  could  solve  the  shortage  in 
our  own  way. 

Would  the  two  years  of  general  practice 
before  taking  up  a specialty  be  a bad  thing? 
G.P.s  say,  “no,”  they’ve  often  wished  for 
specialists  that  saw  not  just  an  eye,  or  her- 
nia, but  a whole  person.  Every  specialist 
coidd  not  help  but  benefit  by  a general 
practice  background.  After  spending  time 


in  general  practice,  the  specialty  training 
time  could  be  cut— all  of  us  who  teach  have 
immediately  given  older  residents  (coming 
back  from  general  practice)  more  responsi- 
bility sooner.  Learning  to  assess  many  pa- 
tients from  a general  point  of  view  cannot 
help  but  make  a better  surgeon,  internist, 
psychiatrist,  dermatologist,  pediatrician. 
Thus,  the  specialties  would  gain  from  such 
a crash  program  and  probably  residency 
times  could  be  cut  because  of  the  better 
motivation  and  G.P.  background  of  these 
older,  more  experienced  men. 

It  seems  to  me,  that  once  started,  many 
men  would  stay  on  in  general  practice,  for 
they  would  realize  what  a rewarding  life 
it  can  be,  a fact  seldom  pointed  out  to 
medical  students  taught  solely  by  full-time 
specialists.  Those  men  committed  to  a spe- 
cial progiam,  knowing  that  it  would  be 
only  two  years,  could  be  encouraged  to  prac- 
tice in  ghettoes  or  depressed  areas  where 
physicians  are  loathe  to  settle  for  life;  an- 
other political  talking  point  negated. 

Many  medical  students  are  married.  A 
wife  who  has  done  without,  to  see  her  hus- 
band through  school,  and  who  has  lived 
in  the  substandard  housing  that  surrounds 
most  medical  schools  will  enjoy  being  the 
wife  of  “the  doctor,”  and  the  approbation 
that  goes  with  it  in  any  community.  For 


538 


Illinois  Medical  Journal 


once,  she’ll  be  more  than  one  of  the  many 
unknown  wives  of  those  lowest  in  the  hier- 
archy. 

But  this  suggestion  for  a crash  program 
is  just  that— “if”  the  pressure  is  suddenly 
put  to  bear  to  produce  more  family  doc- 
tors. Senator  Kennedy,  with  his  phenomen- 
al press  coverage  is  making  the  “if”  rather 

The  controversy 

Over-the-counter  sales  of  vitamin  E have 
more  than  doubled  in  the  past  few  years. 
There  is  no  scientific  basis  for  the  popular- 
ity of  vitamin  E.  It  stems  from  word-of- 
mouth  recommendations  among  laymen 
and  certain  physicians.  There  is  no  doubt 
that  the  product  is  controversial.  Its  thera- 
peutic value  is  unsettled  despite  the  many 
reports  in  the  world  medical  literature. 
Most  of  these  are  animal  studies. 

Vitamin  E is  the  name  of  a group  of 
closely  related  tocopherols.  These  com- 
pounds act  as  antioxidants  in  naturally-oc- 
curring fats  by  inhibiting  the  oxidation  of 
unsaturated  fatty  acids  and  vitamins  A and 
C.  Alpha-tocopherol  is  the  most  plentiful 
type  of  vitamin  E,  and  is  available  in  oral 
and  parenteral  forms,  mainly  as  D-alpha- 
tocopherol  acetate. 

Vitamin  E is  widely  distributed  in  ani- 
mal and  vegetable  foods  and  is  found  in 
most  vegetable  oils  and  leafy  vegetables. 
Wheat  germ  oil  is  especially  rich  in  E.  Eor 
these  reasons,  a deficiency  of  the  vitamin  is 
rarely  encountered.  Infants  may  require  sup- 
plementary vitamin  E when  dietary  fat  is 
markedly  reduced  as  well  as  children  with 
prolonged  steatorrhea.  Reports  show  that 
premature  infants  with  hemolytic  anemia 
respond  to  vitamin  E. 

Opinions  vary  widely  as  to  the  value  of 
alpha-tocopherol  in  the  prophylaxis  and 
treatment  of  various  diseases.  The  propo- 
nents of  the  controversial  vitamin  claim  that 
it  prevents  clotting  of  blood  via  fibrinolysis. 
As  an  antioxidant,  tissues  (including  the 
heart  and  brain)  need  less  blood.  In  addi- 
tion, vitamin  E is  a capillary  and  artery 


possible.  If  we  must  provide  family  doctors 
in  a hurry,  we  do  have  a means  to  put 
(current  figures)  graduates  in  family  prac- 
tice within  one  academic  year.  It  might  just 
avert  a takeover.  Eaults  our  system  might 
have,  yet  all  critics— domestic  and  foreign— 
agree  that  American  medicine  is  still  the 
best  in  the  world.  Let’s  keep  it  that  way. 

Hugh  A.  Johnson,  M.D. 

over  Vitamin  E 

dilator.  And  finally,  vitamin  E prevents  ex- 
cess scar  tissue.  Consequently,  it  is  useful  in 
Dupuytren’s  contracture  and  Peyronie’s 
disease. 

The  proponents  of  E have  used  these 
four  functions  of  the  vitamin  as  rationale 
in  the  treatment  or  prophylaxis  of  coronary 
heart  disease,  hypertension,  venous  throm- 
bosis, intermittent  claudication,  muscular 
dystrophy,  amyotrophic  lateral  sclerosis, 
threatened  or  habitual  abortion,  infertility, 
diabetes,  nephritis,  and  many  other  condi- 
tions. 

However,  despite  reports  and  claims  to 
the  contrary,  most  physicians  are  not  con- 
vinced that  alpha-tocopherol  will  do  this. 
Here  is  where  we  stand  today.  J.  F.  Stare 
was  quoted  as  saying,  . . To  the  best  of 
our  knowledge,  ill  health  in  humans  in  the 
United  States  of  America  has  never  been 
associated  with  a lack  of  vitamin  E nor  has 
it  been  improved  by  giving  extra  amounts 
of  vitamin  E.  . , .” 

Dr.  Evan  V.  Shute,  the  chief  proponent 
of  vitamin  E states,  “.  . . Now  any  heart 
patient  can  treat  his  own  condition  better 
than  the  best  cardiovascular  specialist  in 
the  country  by  going  to  a health  food  store 
and  asking  for  vitamin  E across  the  coun- 
ter. Isn’t  it  time  that  the  cardiologists 
swallowed  their  pride  and  tried  to  find  out 
what  so  many  laymen  already  know?  . . .” 

We  wish  it  were  this  simple  to  treat 
serious  diseases.  Unfortunately  too  much 
reliance  is  placed  on  subjective  evidence 
and  too  little  on  objective  findings,  espe- 
cially when  the  product  in  question  is  safe 
to  take  in  almost  any  dosage. 

T.  R.  Van  Dellen,  M.D. 


Inflation  takes  a big  bite 

Inflation  continues  to  rob  workers  of  increased  earnings.  A worker 
who  10  years  ago  was  making  $6,000  a year,  and  who  today  is  earning 
$9,000,  is  actually  only  $340  better  off. 


for  November,  1970 


539 


ILLINOIS 

MEDICAL 

ASSISTANTS 

ASSOCIATION 


REPORT 


What  every  doctor  should  know . . . 

By  Jessie  Breinig/Chicago 


Medical  Assistants  in  Illinois,  employed 
by  a practicing  M.D.,  should  become  mem- 
bers of  the  Illinois  Medical  Assistants  Asso- 
ciation. 

d’he  objects  of  this  organization  are: 

1. To  elevate  the  standards  among  those 
employed  as  Medical  Assistants. 

2.  To  encourage  its  members  at  all  times 
to  practice  medical  ethics,  honesty  and 
loyalty,  and  to  render  more  efficient 
service  to  the  medical  profession. 

3.  To  promote  an  educational  program 
designed  to  enlist  those  interested  in  a 
career  as  a medical  assistant. 

Illinois  Medical  Assistants  Association  has 
the  approval  of  the  Illinois  State  Medical 
Society  and  is  affiliated  with  the  American 


Association  of  Medical  Assistants,  approved 
by  the  American  Medical  Association. 

This  Association  is  declared  to  be  non- 
profit, it  is  not  nor  shall  it  ever  become  a 
trade  union  or  collective  bargaining  agency. 
Doctor,  encourage  your  Medical  Assistant  to 
join  Illinois  Medical  Assistants  Association. 
Not  only  will  she  profit  from  it  because  of 
its  educational  and  teaching  programs,  but 
she  will  also  enjoy  the  association  of  other 
women  throughout  the  state,  who  are  dedi- 
cated to  the  work  of  the  Medical  Assistant. 

Further  information  regarding  member- 
ship in  this  organization  can  be  obtained 
through  Mrs.  Norma  Domanic,  150  Ash 
Street,  New  Lennox,  111.  60451  or  Mrs. 
Vivian  Kraft,  R.R.#2,  Normal,  111.  61761. 


The  dying  patient  speaks  out 

It  has  been  said  that  80%  of  dying  patients  know  that  they  are  dying 
and  would  wish  to  talk  about  it  and  that  80%  of  doctors  deny  this  and 
believe  that  the  patient  should  not  be  told.  My  experience  with  patients  in 
chronic  renal  failure  showed  that  all  these  patients  had  considered  their 
own  death  and  that  most  were  able  to  discuss  their  feelings  and  beliefs 
with  awareness  and  relief.  Only  a small  number  used  the  defense  of  de- 
nial and  stated  that  they  had  not  envisaged  the  matter  as  applying  to 
themselves.  From  their  manner  of  conversation  characterized  by  shifts  of 
direction  and  silences  it  was  clear,  however,  that  death  as  a personal  pos- 
sibility was  present  in  their  thoughts,  though  they  were  not  prepared  to 
discuss  it  openly  at  that  particular  time. 

This,  then,  would  appear  to  be  the  6rst  major  point— namely,  that  seri- 
ously ill  patients  do  consider  death  as  a possible  outcome  and  welcome 
the  chance  to  talk  about  their  feelings.  The  fact  of  sharing  this  fear  with 
the  doctor  is  in  itself  therapeutic  and  promotes  more  comfortable  communi- 
cation between  patient  and  doctor.  It  must  be  emphasized,  however,  that 
discussion  of  this  fear,  whether  or  not  it  is  founded  in  reality,  should  be 
carried  out  only  when  the  relationship  between  patient  and  doctor  is  suf- 
ficiently close;  both  should  have  reached  the  stage  of  feeling  at  ease  with 
each  other.  (W.  A.  Cramond.:  Psychotherapy  of  the  Dying  Patient,  British 
Medical  Journal  (Aug.  15)  1970,  pages  389-393.) 


5-10 


Illinois  Medical  Journal 


Looking  for  a Place  to  Practice? 
Placement  Service  Lists  Openings 


In  an  effort  to  reduce  the  number  of 
towns  in  Illinois  needing  practicing  physi- 
cians, the  Journal  is  publishing  synopses 
submitted  to  the  Physicians  Placement 
Service  concerning  openings  for  doctors. 

Physicians  who  are  seeking  a place  to 
practice  or  who  know  of  any  out-of-state 
physicians  seeking  an  Illinois  residence  are 
asked  to  notify  the  placement  service. 

Information  and  comments  are  also  re- 
quested from  physicians  living  near  the 
communities  listed  as  to  the  real  need  and 
the  ability  of  the  town  to  support  addi- 
tional physicians. 

Inquiries  and  comments  should  be  di- 
rected to  Mrs.  Robert  Swanson,  Secretary, 
Physicians  Placement  Service,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave., 
Chicago  60601. 

Subsequent  to  the  listings  over  the  past 
30  months,  the  following  supplemental  list 
of  openings  is  furnished.  This  will  be  con- 
tinued next  month. 

BUREAU  COUNTY:  Princeton;  popula- 
tion: 6500.  Trade  area:  10,000.  Opening 
with  two  physicians  or  solo.  Eight  doctors 
here  including  four  G.Ps.  Hospital  three 
blocks  from  office,  130  beds.  Small  industry 
and  agriculture.  Protestant  and  Catholic 
churches.  Public  and  parochial  schools. 
Country  club  with  golf  course.  Sixty  miles 
from  Peoria.  New  office  ready  and  waiting. 
Weekend,  holiday  and  vacation  relief  call. 
Eor  further  information  contact:  G.  E. 
Rathburn,  M.D.,  730  South  Main,  Prince- 
ton. 

COOK  COUNTY:  Chicago.  Opening  for 
associate  medical  director  of  large  manu- 
facturing company.  Prefer  general  practi- 
tioner, internist  or  surgeon.  For  further  in- 
formation contact:  Mr.  Carl  Von  Ammon, 
Boyden  Associates,  111  W.  Monroe,  Chi- 
cago. Phone:  312-782-1581. 

COOK  COUNTY:  Chicago.  Forty-five  man 
group  established  in  1941;  largest  private 
medical  clinic  in  Cook  County.  Opening  for 
GP  or  internist.  All  specialties  represented 
in  group.  Salary:  $24,000  for  GP;  $26,000 


for  internist.  Opportunity  for  partnership 
after  two  years.  Nearby  Ravenswood  Hos- 
pital expanding  to  500  beds  in  1971.  One 
block  from  clinic.  For  further  information 
contact:  Kenneth  Hatfield,  M.D.,  Field 

Clinic,  4600  N.  Ravenswood,  Chicago. 
Phone:  312-561-2525. 

COOK  COUNTY:  Chicago.  Opening  for 
an  associate— GP  or  internist.  Open  im- 
mediately. Financial  arrangement  nego- 
tiable. Doctor  owns  building  with  pharm- 
acy, dentist  and  optometrist  as  tenants. 
Near  Mt.  Sinai  and  Evangelical  Hospitals. 
For  further  information  contact:  Marvin 
Lerner,  M.D.,  4900  South  Archer  Ave.,  Chi- 
cago. Phone:  312-581-7056. 

DUPAGE  COUNTY:  Warrenville;  popula- 
tion: 5000.  Opening  for  GP  or  internist. 
Percentage  or  salary.  Three  nearby  hospi- 
tals. Thirty  miles  west  of  Chicago.  For  fur- 
ther information  contact:  Robert  Allison, 
M.D.,  Warrenville.  Phone:  312-393-1221  or 
365-6364. 

EFFINGHAM  COUNTY:  Effingham;  pop- 
ulation: 11,000.  Trade  area:  60,000.  Nine 
physicians.  St.  Anthony  Hospital;  64  bads. 
Seventy  miles  from  Champaign  & Terre 
Haute;  100  miles  from  St.  Louis.  Four  drug 
stores.  Agriculture  and  industry.  Fifteen 
Protestant  and  Catholic  churches.  Six  grade 
schools;  two  high  schools.  Three  golf 
courses,  two  indoor  pools.  Lake,  etc.  Office 
space  available.  For  further  information 
contact:  Mr.  David  Lustig,  111  W.  Jeffer- 
son, Effingham.  Phone:  217-342-2877. 
FRANKLIN  COUNTY:  Christopher:  pop- 
ulation: 3,000.  Trade  area:  9000.  Opening 
at  Miners  Hospital;  34  beds.  Hospital  will 
provide  office,  examining  rooms,  etc.  Com- 
plete outside  practice  permitted.  Six  active 
physicians  on  staff.  Nine  nurses:  three  tech- 
nicians. Travel  expenses  to  job  will  be  pro- 
vided. Outpatient  clinic  with  surgeon  avail- 
able two  days  a week  for  clinic.  New  grade 
and  high  school.  Catholic  and  Protestant 
churches.  Three  miles  from  largest  man- 
made lake  in  Illinois  to  be  completed  in 
1971.  Two  new  junior  colleges  within  20 
minute  drive.  One  hundred  miles  south  of 
St.  Louis.  For  further  information  contact: 
Mr.  Eugene  Helfrich,  Miners  Hospital, 
Effingham. 


for  November,  1970 


541 


Editor’s  Note  „ . . r 

roilowmg  IS  a synopsis  or  a report  to 

the  Illinois  Dejrartment  of  Public  Health,  Division  of 
Health  Care  Facilities  & Chronic  Illness,  on  the  Pilot  Proj- 
ect on  Medical  Review  of  IDPA  patients  in  Long  Term 
Care  Facilities.  The  report  was  prepared  by  John  W.  Bow- 
den, M.D.,  chairman.  Long  Term  Institutional  Care  Com- 
mittee, Will-Gruncly  County  Medical  Society. 

In  Will  and  Gruntly  Counties 


Pilot  project 


in  medical 


A nine-month  pilot  project  on  medical 
review  of  public  aid  patients  in  extended 
care  facilities  by  physicians  in  Will  and 
Grundy  counties  was  successfully  conclud- 
ed June  30.  The  unicpie  project  was  started 
at  the  request  of  the  Illinois  Department 
of  Pidrlic  Health  to  provide  local  physician 
participation  in  the  medical  review  pro- 
gram. The  project  was  so  successful  that 
the  Will-Grundy  Medical  Society  has  au- 
thorized it  be  continued  as  an  ongoing 
program. 

Medical  review  of  ECF’s  is  recpiired  by 
federal  law  which  provides  for:  (a)  a regu- 
lar review  program  including  each  patient’s 
need  for  skilled  nursing  home  or  inter- 
mediate care;  (b)  periodic  inspections  to  be 
made  in  all  skilled  nursing  homes  and  in- 
termediate care  facilities  within  the  state 
by  one  or  more  medical  review  teams  com- 
])oscd  of  physicians  and  other  appropriate 
health  and  social  service  personnel;  and 
(c)  complete  reporting  by  the  teams  of  their 
findings  and  recommendations. 

Will-Grundy  County  Medical  Society 
designated  its  Long  Term  Institutional 
Care  Committee  to  implement  the  pilot 
program.  This  committee  combined  its  ac- 
tivities with  the  Utilization  Review  Com- 
mittee that  already  was  performing  medical 


review  of  several  ECFs  in  the  community. 
The  Medical  Society  felt  its  participation 
in  this  program  would  further  demonstrate 
its  concern  for  maintaining  and  upgrading 
the  level  of  care  in  ECFs  for  all  patients. 
The  Society  also  felt  local  physicians  could 
better  evaluate  the  quality  of  care  in  the 
area’s  ECFs  than  could  outside  consultants. 

The  cases  for  review  were  selected  by  the 
Department’s  Division  of  Health  Care  Fa- 
cilities and  Chronic  Illness.  Cases  were  sub- 
mitted to  the  review  committee  on  a report 
form  containing  the  evaluation  of  the  phy- 
sician and  a registered  nurse.  These  reports 
were  assigned  to  an  appropriate  physician 
member  of  the  review  committee  who 
visited  the  facility,  studied  the  patient’s 
medical  record,  and  discussed  the  patient 
with  the  administrative  and  nursing  staff. 
When  indicated,  he  personally  examined 
the  patient. 

There  are  nine  nursing  homes  and  four 
homes  for  the  aged  with  a total  bed  capacity 
of  1,211  in  the  two  county  area.  All  homes 
but  one  (because  it  was  recently  construct- 
ed) were  visited  by  the  review  committee. 
After  review,  cases  were  returned  to  the 
Medical  Society  office  with  the  physician’s 
bill  for  performing  the  review.  A copy  of 
the  review  was  made  for  Society  records 
and  the  case  was  then  returned  to  the  Di- 


542 


Illinois  Medical  Journal 


vision  of  Health  Care. 

As  soon  as  the  Medical  Society  received 
the  Department  of  Public  Health’s  pay- 
ment, it  issued  a check  to  the  physician. 
During  the  project  no  money  was  allowed 
for  the  administrative  services  of  the  So- 
ciety’s office.  However,  it  has  since  been 
agieed  that  such  administrative  costs  will 
be  billed  for  in  the  future. 

Project  results 

Positive  results  of  the  pilot  project  are: 

1.  Increased  physician  cooperation  and  par- 


The  1970  ISMS  House  of  Delegates 
passed  a resolution  (70M-24)  endorsing 
county  medical  society  participation  in 
this  medical  review  process. 

2.  Efforts  should  be  made  to  standardize  all 
essential  forms  used  by  physicians  in 
treating  ECF  patients  and  by  those  phy- 
sicians performing  the  medical  review. 

3.  The  Departments  of  Public  Health  and 
Public  Aid  should  accelerate  efforts  to 
computerize  all  information  relating  to 
IDPA  patients.  This  implies  that  ECFs 
would  provide  the  necessary  information 


review  successfully  completed 


ticipation,  especially  an  improvement  in 
visits  to  the  facilities. 

2.  Better  knowledge  on  the  part  of  physi- 
cians of  the  level  of  care  being  delivered 
in  ECFs. 

3.  An  imjarovement  in  the  quality  of  medi- 
cal records. 

4.  Apparent  improvement  in  patient  trans- 
fer between  ECFs,  especially  the  transfer 
of  records. 

5.  Improved  coordination  of  efforts  be- 
tween physicians,  facility  nursing  services 
and  administrative  personnel. 

6.  The  start  of  an  association  of  nursing 
homes  that  will  provide  a forum  to  dis- 
cuss common  problems  ranging  from 
management  to  the  delivery  of  services. 

Recommendations 

Will-Grundy  County  Medical  Society 
made  the  following  recommendations  to 
the  Illinois  Department  of  Public  Health: 

1.  That  all  county  medical  societies  be 
given  the  opportunity  to  accept  or  reject 
a plan  to  provide  medical  review  in 
ECFs.  Any  agreement  can  be  terminated 
by  either  party.  If  a county  society  de- 
cides it  does  not  want  to  cooperate  in 
such  a program,  the  State  of  Illinois  may 
employ  a local  physician  (s)  on  a regional 
or  area  basis. 


so  that  profiles  could  be  obtained  by: 
patient;  disease  category;  utilization;  phy- 
sician visits;  laboratory  services;  poten- 
tial benefit  from  occupational  or  physical 
therapy;  and  over-all  patient  review  by 
facility. 

4.  Savings  in  public  aid  funds  achieved 
through  more  efficient  reporting  methods 
should  be  applied  toward  more  adequate 
payment  to  ECFs  through  paying  on  a 
usual  and  customary  charge  basis.  Such 
payment  practice  was  recommended  to 
IDPA  in  1968,  by  the  Ad  Hoc  Commit- 
tee on  Public  Aid  payment. 

Conclusions 

The  Will-Grundy  County  Medical  So- 
ciety feels  that  county  society  participation 
in  these  programs  is  desirable  and  essential. 
Attempts  should  be  made  to  implement 
similar  programs  on  a statewide  basis.  As 
indicated,  it  is  realized  that  all  county  so- 
cieties cannot  engage  in  these  programs 
and  in  such  cases  the  Department  of  Pub- 
lic Health  has  to  employ  a reviewing  phy- 
sician on  a local  or  regional  basis.  Finally, 
it  is  essential  to  this  program  to  computer- 
ize all  information,  to  change  the  present 
payment  mechanism,  and  for  ECFs  to 
voluntarily  standardize  forms  used  by  phy- 
sicians. 


for  November,  1970 


543 


Pacemaker  for  ailing  brains  in  ten  years? 


Within  the  next  ten  years,  pacemakers 
similar  to  cardiac  pacemakers  may  be  used 
in  diagnosing  and  treating  brain  disorders, 
reports  the  National  Society  for  Medical 
Research. 

A joint  project  by  a team  of  scientists  at 
Yale  Medical  School  and  an  Aeromedical 
Research  Laboratory  at  Holloman  Air 
Force  Base  in  New  Mexico  has  resulted  in 
a chimpanzee  named  “Paddy”  carrying  on 
a two-way  brain-radio  communication  with 
a computer.  Electrodes  implanted  in  the 
chimp’s  brain  have  enabled  experiments  to 
be  conducted  successfully  for  the  past  year 
and  a half. 

The  experimental  work  “ . . . introduces  a 
new  age  in  research  and  therapy  on  the 
brain  and  mind,”  according  to  Dr.  Jose 
M.  R.  Delgado,  professor  of  physiology  at 
Yale  and  leader  of  the  experimental  group. 

According  to  Dr.  Delgado,  it  is  also  tech- 
nically possible  for  one  brain  to  communi- 
cate directly  with  another  brain  using  the 
electronic  and  computer  techniques  shown 
to  be  feasible  with  this  experiment.  He  in- 
dicated that  there  are  several  applications 
of  this  technique  such  as  treating  brain 
disorders  in  man  and  particularly  diseases 


known  to  be  caused  by  electrical  disturb- 
ances in  the  brain. 

One  application  in  the  very  near  future, 
according  to  the  Doctor,  involves  patients 
with  epilesy,  intractable  pain  and  Parkin- 
son’s disease,  who  may  now  be  treated  or 
diagnosed  with  the  aid  of  cumbersome  elec- 
tronic instrumentation  that  restricts  their 
hospital  mobility.  He  noted  that  this  new 
development  may  aid  in  the  diagnosis  or 
therapy  of  such  brain  disorders  because  of 
its  convenience  to  both  patients  and  phy- 
sicians. A more  far-reaching  ajaplication, 
but  one  which  may  occur  in  the  present 
decade,  he  said,  will  be  brain  pacemakers 
which,  like  cardiac  pacemakers,  will  be 
miniaturized  and  implanted  in  the  patient’s 
body  and  will  receive  and  send  electrical 
information. 

Using  such  a brain  pacemaker,  an  epilep- 
tic in  the  future  may  have  important  areas 
of  his  brain’s  electrical  activity  monitored 
by  remote  computer.  Electrical  disturb- 
ances, which  might  have  led  to  convulsive 
attacks,  would  be  detected  and  corrected  by 
the  computer  while  the  patient  continued 
normal  activities,  uninterrupted  by  the 
now-blocked  attack. 


On  specialization 

“.  . . for  so  many  and  of  such  narrow  scope  are  the  facets  of  medicine 
that  the  hackneyed  description  of  a specialist  as  ‘a  man  who  knows  more 
and  more  about  less  and  less,  till  finally  he  knows  everything  about  noth- 
ing,’ seems  almost  justified. 

This  is  due  to  what?  I would  say  that  it  is  undoubtedly  due  to  the  amaz- 
ing advances  in  science  and  the  discovery  of  how  many  there  are  which  can 
be  partially  adapted  to  the  needs  of  medicine.  This  naturally  increased 
enormously  the  load  of  medical  literature,  so  much  so  that  in  1962,  the 
editor  of  the  World  Medical  Journal  told  us  that  each  night,  between 
sleeping  and  waking,  more  than  400  new  articles  appeared  in  medical 
journals,  and  there  is  no  reason  to  believe  that  flood  has  lessened,  or  to 
even  hope  that  it  has.  True,  many  of  those  articles  were  scarcely  deserving 
of  editorial  acceptance,  but  as  long  as  this  curious  belief  exists,  that  ap- 
pearance in  print  confers  on  the  author  the  simulacrum  of  an  authority, 
editors  will  continue  to  be  deluged  with  copy,  some  good,  much  bad,  and 
most  indifferent. 

A description  of  the  ambitions  of  a budding  young  doctor  in  verse  may 
prove  to  show  how  strongly  this  was  held: 

The  pen,  so  springs  the  constant  hope  of  all  devout  physicians. 

Is  mightier  than  the  stethoscope  and  runs  to  more  editions; 

So  while  he  waged  bacillic  wars,  or  sewed  a clever  suture. 

His  mind  still  hummed  with  metaphors,  laid  up  against  the  future.” 
(Sir  Alexander  Murphy.:  On  Specialization.  Med.  Jl.  of  Australia  Sup- 
plement (Saturday,  Nov.  8)  1969,  pgs.  49-51.) 


544 


Illinois  Medical  Journal 


Official  Call  For  Scientific  Exhibits 

1971  ANNUAL  MEETING  OE  ISMS 
Arlington  Park  Towers  — May  17-18-19 

The  Committee  on  Scientific  Assembly  invites  members  of  the  Illinois 
State  Medical  Society  to  submit  applications  for  scientific  exhibits  at  the 
Society’s  1971  annual  meeting  May  17-19  at  the  Arlington  Park  Towers, 
Arlington  Heights,  Illinois. 

To  facilitate  arrangements  for  the  proper  location  of  the  scientific  ex- 
hibits, individuals  and  organizations  desiring  space  at  the  meeting  are  re- 
quested to  file  an  apjalication  before  March  15,  1971,  giving  the  basic  equip- 
ment which  will  be  needed.  Awards  are  given  to  exhibits  of  exceptional 
value.  Assignments  are  made  as  exhibits  approved  by  the  Committee  on 
Scientific  Assembly. 

There  is  no  fee  charged  for  scientific  exhibits,  but  the  exhibitor  must  pay 
the  cost  of  installing  the  exhibit,  of  tables  and  chairs  that  may  be  rented, 
for  alterations  or  all  other  construction.  Single  exhibit  space  is  8.x  10  feet. 

Those  interested  in  providing  an  exhibit  are  requested  to  file  an  applica- 
tion and  a full  description  of  the  exhibit. 

DEADLINE  EOR  APPLICATIONS:  March  15,  1971. 

Contact:  Director  of  Scientific  Exhibits 
Illinois  State  Medical  Society 
360  North  Michigan  Avenue 
Chicago,  Illinois  60601 

Director  of  Scientific  Exhibits 
Illinois  State  Medical  Society 
360  North  Michigan  Avenue 
Chicago,  Illinois  60601 

Please  send  Scientific  Exhibit  Application  Forms  to: 

NAME  

ADDRESS  

CITY  & ZIP  CODE  

(Please  Print) 


Do  you  listen  . . . and  remember? 

For  about  seven-tenths  of  his  waking  day,  the  average 
person  is  involved  in  some  form  of  verbal  communication. 
Nearly  half  that  time,  he  is  on  the  listening  end.  Unfort- 
unately, according  to  Dr.  Robert  Haakenson,  very  little 
of  what  we  hear  is  lastingly  recorded. 

Within  24  hours,  the  community  relations  expert  says, 
we  forget  50  per  cent  of  what  we  heard.  Another  25  per 
cent  is  erased  in  the  next  two  weeks.  In  short,  we  lose 
three-fourths  of  what  we  hear. 

The  biggest  reason  for  our  forgetfulness  is  poor  reception. 
Our  listening  speed  is  approximately  four  times  as  fast 
as  words  are  spoken.  So  we  habitually  "think  ahead"  of 
the  speaker  and  are  inclined  to  stop  listening  while  our 
subconscious  waits  for  him  to  catch  up.  What  he  says  in  such 
lapses  is  bound  to  make  little  impression— but  it  could  be 
most  important. 

When  you  feel  your  attention  is  flagging,  remember 
the  old  warning,  "Stop,  Look  and  Listen!" 


for  November,  1970 


545 


ISMS  SERVICE 


Health  Insurance  Claim  Form  available 

Copies  of  the  HIC  form  may  be  obtained  by  contacting  Illinois  State  Medical  So- 
ciety, 360  N.  Michigan  Avenue,  Chicago  60601. 


HEALTH  INSURANCE  CLAIM  - GROUP  OR  INDIVIDUAL 


PART  A 

TO  BE  COMPLETED  BY  PATIENT  (INSURED) 

Spaced  for  Typeztfriter  — Marks  for  Tabulator  Appear  on  this  Line 

PATIENT'S  NAME  AND  ADDRESS 

DATE  OF  BIRTH 

INSURED’S  NAME  IF  PATIENT  IS  A DEPENDENT 

NAME  OF  INSURANCE  COMPANY 

1 POLICY  NUMBER 

1 

INSURED'S  SOCIAL  SECURITY  NUMBER 

AUTHORIZATION  TO  PAY  BENEFITS  TO  PHYSICIAN:  1 htFoby  Authoriz* 
psymant  dlradly  to  th«  underiignad  Physician  of  the  Surgical  and/or  Medical 
Banafth,  if  any,  otherwise  payable  to  me  for  his  services  as  described  below 
but  not  to  eiceed  the  reasonable  and  customary  charge  for  those  services. 

L SIGNED  (INSURED  PERSON) 

F DATC 

AUTHORIZATION 
undersigned  Physic! 
my  examination  or 

TO  RELEASE  INFORMATION;  t heraby  authorize  the 
an  to  release  any  information  acquired  in  the  course  of 
treatment. 



F DATS 

PART  B 

ATTENDING 

PHYSICIAN’S  STATEMENT 

t.  DIAGNOSIS  AND  CONCURRENT  CONDITIONS 

(IP  OIAONOSIS  CODE  OTHER  THAN  ICOA*  USED.  GIVE  NAME); 


2.  IS  CONDITION  DUE  TO  INJURY  OR  SICKNESS  ARISING  OUT  OF  PATIENT  S EMPLOYMENT?  PREGNANCY? 

Yes  □ NO  □ Yes  □ NO  □ 


3.  REPORT  OF  SERVICES  (OR  ATTACH  ITEMIZED  BILL)  (IF  PREVIOUS  FORM  SUBMITTED  TO  THIS 

CARRIER.  YOU  NEED  SHOW  ONLY  OATES  AND  SERVICES  SINCE  LAST  REPORT)  PROCEDURE 

CODE  — IF  USED 

DATE  OF  PLACE  OF  ( IF  CORK  OTHCR  THAN 

SERVICES  services!  DESCRIPTION  OF  SURGICAL  OR  MEDICAL  SERVICES  RENDERED  CFT**  USED.  aiVC  NAMC 


IF  YES.  APPROXIMATE  DATE 
PREGNANCY  COMMENCED. 
DATE 


CHARGES 


TOTAL  CHARGES  ► $ - 


^ |0 — Doctor’s  Office  IH — Inpatient  HospitsI  NH— -Nursing  Home 

H — Patient's  Home  OH — Outpatient  Hospital  OL — Other  Locations 

lyp  *ICDA — International  Classification  of  Diseases 

•*CPT — Current  Procedural  Terminology  (current  edition) 

4.  DATE  SYMPTOMS  FIRST  APPEARED  OR  ACCIDENT  HAPPENED. 

5.  DATE  PATIENT  FIRST  CONSULTED  YOU  FOR  THIS  CONDITION, 

S.  PATIENT  EVER  HAD  SAME  OR  SIMILAR  CONDITION? 
YES  Q NO  Q IF  •’YES  ’ WHEN  AND  DESCRIBE; 

7.  PATIENT  STILL  UNDER  YOUR  CARE  FOR  THIS  CONDITION  7 
YtS  □ NO  □ 

8 PATIENT  WAS  CONTINUOUSLY  TOTALLY  DISABLED 
(UNABLE  TO  WORK). 

FROM  THRU 

9.  PATIENT  WAS  PARTIALLY  DISABLED. 
FROM  THRU 

lO  IF  STILL  DISABLED.  DATE  PATIENT  SHOULD  BE  ABLE  TO  RETURN 
TO  WORK. 

1 !.  PATIENT  WAS  HOUSE  CONFINED. 

FROM  THRU 

12.  DOES  PATIENT  HAVE  OTHER  HEALTH  COVERAGE  7 
,es  □ □ IF  "YES"  PLEASE  IDENTIFY 


I DO  NOT  ACCEPT  ASSIGNMENT. 


□ 


SIGNATURE 


TELEPHONE 


STREET  ADDRESS  CITT  OR  TOWN  STATE  OR  PROVINCE  ZIP  CODE 


MEMORANDUM  REGARDING  DISPOSITION  OF  THIS  FORM  ON  REVERSE  SIDE  Approved  by  Council  on  Medical  Service.  AMA  10-67 


546 


Illinois  Medical  Journal 


ECONOMIC 

news 


A service  of  the  Public  Relations  and  Economics  Division 


By  Joseph  J.  Lotharius 

ISMS  TRUSTEES  RE  AFFIRMED  THE  USUAL  AND  CUSTOMARY  FEE  CONCEPT  AS  THE  BASIS  FOR 

physician  payment  (initially  adopted  in  1966)  rather  than 
the  relative  value  scale.  The  action  was  taken  at  the  Oc- 
tober board  meeting  after  Trustees  learned  that  the  de- 
mand for  ISMS  Relative  Value  schedules  was  continuing. 
Board  members  agreed  that  the  Relative  Value  studies 
should  not  be  reprinted  because  the  information  contained 
in  these  booklets  is  as  outdated  as  the  relative  value  con- 
cept. All  Illinois  county  medical  societies  will  be  informed 
of  the  Board’s  decision. 

CAN  YOU  VISUALIZE  A ROLE  FOR  BLUE  SHIELD  IN  A PRE-PAID  HEALTH  PLAN? 

No,  says  Dr.  Cecil  C.  Cutting,  executive  director,  Kaiser 
Permanente  Medical  Group,  Oakland,  Calif.,  a guest  speak- 
er at  a recent  national  conference  of  Blue  Shield  execu- 
tives. However,  Dr.  Cutting  thinks  that  Blue  Shield,  with 
the  cooperation  of  a medical  society,  could  correlate  a 
number  of  groups  under  one  program.  He  said  such  co- 
operation could  tie  together  such  necessary  functions  as 
marketing  and  record  keeping. 

IF  A NEW  HEALTH  CARE  DELIVERY  SYSTEM  IS  INTRODUCED,  BLUE  SHIELD  SHOULD 

BE  A PART  OF  IT,  according  to  William  E.  Ryan,  senior 
vice-president.  Marketing,  National  Association  of  Blue 
Shield  Plans,  speaking  at  the  national  Blue  Shield  con- 
ference. Ryan  said  thus  far  the  “Blues”  have  not  felt 
the  competition  from  Foundations  for  Medical  Care 
in  those  areas  where  the  latter  exist.  “Their  impact  will 
grow  as  their  enrollment  grows,”  according  to  Ryan.  He 
said  the  health  market  is  ready  for  a change  and  is  looking 
for  something  new.  “We  must  convince  the  market  that 
Blue  Shield  is  the  best  way  to  go,”  Ryan  said.  He  pointed 
out  that  in  order  to  achieve  this.  Blue  Shield  must  provide 
the  public  with  the  proper  environment  to  make  a deci- 
sion.” 


SOGIO 


/or  November,  1970 


547 


WILL  MEDICARE  PAY  PHYSICIANS  FOR  MONTHLY  VISITS  TO  ECF  PATIENTS  IF  THE  VISIT 

IS  MADE  ONLY  TO  CONFORM  WITH  ILLINOIS  LAW?  Yes, 
says  the  Bureau  of  Health  Insurance,  Social  Security 
Administration.  BHI  said  regulations  covering  visits  to 
Medicare  patients  in  extended  care  facilities  are  being 
eased  so  that  one  visit  per  month  will  be  “automatically” 
allowed.  “In  the  case  of  ECF  patients  receiving  a non- 
covered  level  of  care  or  patients  in  nursing  homes  that 
are  not  participating  in  ECFs,  one  visit  a month  by  a phy- 
sician can  be  presumed  reasonable  and  necessary,”  accord- 
ing to  BHI.  “Such  a visit,  of  coixrse,  could  also  serve  to 
satisfy  the  30-day  visit  requirement  in  the  ECF  conditions 
of  participation  and  the  state  law.” 

GOVERNMENT  MAY  SOON  BE  SCRUTINIZING  . . . AND  REDUCING  MEDICARE  AND 

MEDICAID  PAYMENTS  TO  HOSPITALS.  The  HEW  Secretary 
could  reduce  “unreasonable”  payments  to  hospitals  if  the 
changes  in  the  Medicare  and  Medicaid  programs  proposed 
by  Rep.  Wilbur  Mills,  chairman  of  the  House  Ways  and 
Means  Committee,  are  adopted.  A report  printed  in  a 
recent  issue  of  Private  Practice  said  the  Mills’  bill,  de- 
signed to  hold  down  hospital  charges,  would  form  regional 
boards  which  would  determine  what  constitutes  “reason- 
able” hospital  charges. 

Under  the  Mills  bill,  HEW  would  be  ordered  to  publi- 
cize what  costs,  if  any,  were  found  to  be  unreasonably 
charged.  The  bill  would  also  give  states  power  to  determine 
what  hospital  charges  to  Medicaid  were  reasonable. 

MEDICARE  INSURANCE  DEDUCTIBLE  AND  CO-INSURANCE  WILL  INCREASE  IN  '71. 

HEW  has  announced  the  inpatient  hospital  deductible 
under  Part  A of  Medicare  will  be  increased  from  $52  to 
$60  for  benefit  periods  beginning  in  1971.  The  HEW  an- 
nouncement also  specifies  that  co-insurance  amounts  must 
be  proportionate  to  the  inpatient  hospital  deductible.  The 
new  amounts  are  effective  only  with  benefit  periods  starting 
in  1971.  The  present  $52  inpatient  hospital  deductible  and 
related  co-insurance  amounts  remain  in  effect  for  benefit 
periods  starting  in  1970,  even  though  these  periods  extend 
into  1971. 


Ten  ways  to  hetp  your  association 

Keeping  an  association  up  to  par  is  a year-round  job 
for  all  the  members.  Officers  and  staff  plug  away  at  it 
continually,  but  the  need  for  constant  renewal  calls  for 
transfusions  from  everyone.  To  show  how  the  rank  and 
file  can  help,  the  Texas  Automobile  Dealers  Association 
listed  22  suggestions.  Here  are  ten  selected: 

1.  Attend  meetings  regularly.  2.  Show  a personal  in- 
terest. 3.  Stir  up  listless  members.  4.  Promote  a team- 
work spirit.  5.  Be  a peacemaker.  6.  Seek  the  best  inter- 
est of  everyone.  7.  Give  credit  where  it  is  due.  8.  Pre- 
vent meetings  from  bogging  down.  9.  Don't  duck  thank- 
less jobs  that  must  be  done.  10.  Keep  long-range  goals 
in  mind. 


548 


Illinois  Medical  Journal 


^I!4f®«|»»Siiilljj|5|jj|j|j 


iliUli  iliiniUHii 


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SCIENTIFIC 

MEETINGS 


LUXURY  J»ER  s s roTTE  r dam 

of  the  HOLLAND  AMERICA  LINE 


Sailing  from  NEW  YORK  on  January  2,  1971,  to  the  WEST  INDIES 

19-DAY  CRUISE  rates  from  $1,070,00 

Mini-Scientific  Winter  Cruise  12-days  from  New  York  January  2, 1971 , to  Caracas.  Or,  fly  to  Caracas 
on  January  10  and  return  aboard  the  SS  Rotterdam  to  New  York.  Rates  from  . . . $557.50. 

Here's  a golden  opportunity  to  enjoy  a well  deserved  winter  vacation  away  from  the  tensions  and 
pressures  so  common  to  your  profession. 

SEMINARS  WILL  BE  HELD  ON  SHIP  AND  SHORE  THROUGHOUT  THE  CRUISE 

St.  George’s,  Grenada 
Fort-de-France,  Martinique 
Port-au-Prince,  Haiti  St.  Thomas, 

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For  Details  Contact: 


M'GUIRE 

ENTERPRISES.  INC. 


Area  312  372-8302 

CABLE:  MCGUIRECO.  CHICAGO 

230  North  Michigan  Avenue  • Chicago,  Illinois,  60601 


/or  ’November,  1970 


551 


Meeting  Memos 


IVov.  17 — Illinois  State  Psychiatric  In- 
stitute 

Lecture  "Community  Psychiatry— Current  Prospects 

and  Problems” 

ISPI  Auditorium,  1601  W.  Taylor,  Chicago 

Nov.  20 — Diabetes  Association  of  Great- 
er Chicago 

Symposium 

Holiday  Inn,  644  N.  Lake  Shore  Dr.,  Chicago 

Nov.  20-21 — Institute  of  Medicine  of 
Chicago 

Workshop  on  “The  Doctor  and  His  Changing 

Community” 

/\nihassador  West  Hotel,  Chicago 

Nov.  20-21 — University  of  Iowa 

iVorkshop  on  Sports  Medicine 

Ihiiversity  of  Iowa.  Iowa  City,  Iowa 

Nov.  27-29 — National  Commission  on 
Human  Life  Reproduction  and  Rhy- 
thm 

5th  International  Symposiuryt  On  Abortion,  Family 

Planning  And  Sex  Education 

Sheraton  Plaza  Hotel,  Boston 

Nov.  29-Dec.  2 — Association  of  Military 
Surgeons  of  the  U.S. 

77th  Annual  Meeting 

Washington  Hilton  Hotel,  Washington,  D C. 


Nov.  29-Dec.  2 — American  Medical  As- 
sociation 

24th  Clinical  Convention 
Statler  Hilton  Hotel,  Boston 

Nov.  29-Dec.  2 — American  Medical  As- 
sociation 

I2th  National  Conference  on  the  Medical  Aspects 
of  Sports 

Sheraton-Boston  Hotel,  Boston 

Dec.  1 — Illinois  State  Psychiatric  In- 
stitute 

Lecture  “Russian  and  American  Psychiatry— A Com- 
parison” 

ISPI  .Auditorium,  1601  W.  Taylor,  Chicago 

Dec.  4 — Chicago  Surgical  Society 

Scientific  Sessiori 

Chicago  Surgical  Society,  Evanston 

Dec.  5-10 — American  Academy  of 

Dermatology 

29lh  Annual  Meeting 
Palmer  House.  Chicago 

Dec.  9 — University  of  Chicago 

Frontier  iyi  Medicine  Lecture  “Recent  Concepts  in 
the  Management  of  Burns” 

Billing  ,\uditorium,  Billings  Hospital,  Chicago 

Dec.  18-19 — University  of  Kentucky 

Postgraduate  course,  “Practical  Ophthalmology  for 
the  Primary  Physician” 

Tuiversity  of  Kentucky  Medical  Center,  Lexington, 
Kentucky 


Christinas  Seal  Campaign : 

Help  Fight  TB  and  RD 

“Use  Christmas  Seals.  Help  Fight  TB  and  RD.’’  is  the 
theme  ol  the  1970  Christmas  Seal  Campaign,  running  No- 
vember 10  through  December. 

The  goal  set  by  The  Tuberculosis  Institute  of  Chicago 
and  Cook  County  is  to  focus  attention  on  the  Tuberculosis 
problem  and  raise  $1,100,000  to  support  the  fight  against 
TB  and  RD. 

Looking  at  a break-down  of  how  the  contributions  made 
are  spent: 

93^'  stays  within  Chicago  and  Cook  County  to  carry 
out  services  like  free  chest  X-rays,  tuberculin  tests  in 
Inner  City  schools,  and  medical  research  in  emphysema, 
TB  and  other  lung  diseases. 

goes  to  the  National  Tuberculosis  and  Respiratory 
Disease  Association  for  medical  and  social  research  and 
public  health  education. 


.552 


Illinois  Medical  Journal 


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CHICAGO  AREA  OFFICE:  T.  J.  Pandalc,  J.  C.  Kunches,  and  L.  R.  Gannon,  Representatives 

T.  J.  Hoehn,  Consultant 

815  Commerce  Drive,  Suite  102,  Oak  Brook,  Illinois  60521  (312)325-7314 

SPRINGFIELD  OFFICE:  W.  J.  Nattermann,  Representative 
426V2  South  Fifth  Street,  Springfield  62701  (217)  544-2251 


INVESTMENTS  ARE  LIKE  MEDICINE- 
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WE  MAINTAIN  AN  INVENTORY  OF  QUALITY  BONDS  AND  ARE  PROUD  OF 
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WE  ARE  EQUALLY  PROUD  OF  OUR  NAME  AND  REPUTATION. 

SO  MUCH  SO  THAT  WE  FEEL  IT'S  WORTH  ADVERTISING  IN  THESE  TIMES. 

MAY  WE  INTRODUCE  OURSELVES? 

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for  November,  1970 


553 


Doctors  warned  of  crisis 

More  than  1,400  doctors  in  the  New  York 
area  were  told  that  if  America  does  not 
solve  its  mushrooming  drug  addiction  prob- 
lem within  the  next  ten  years  our  civiliza- 
tion may  find  it  difficult  to  survive. 

The  grim  warning  was  sounded  by  a 
distinguished  panel  of  psychiatrists  and 
physicians  speaking  at  a symposium  on 
drug  abuse  sponsored  jointly  by  the  New 
York  Academy  of  Medicine  and  Pfizer  Lab- 
oratories at  the  Americana  Hotel  recently. 

The  increase  in  addiction,  these  experts 
said,  is  geometric  and  already  out  of  hand 
because  there  is  no  clear-cut  or  apparent 
solution.  In  New  York  City  alone,  it  was  re- 
ported, there  were  900  deaths  last  year 
from  drug  overdose. 

The  panel  made  these  essential  points: 

o Education,  whether  it  be  lectures  to 
the  public  or  classes  for  children,  has  little 
effect.  Yoting  drug  users  lack  motivation 
to  stop  and  motivation  must  be  supplied 
before  a cure  can  be  effective. 

• Physicans  see  a growing  menace  in  the 
misuse  of  non-narcotic  drugs  intended  for 
other  uses  such  as  amphetamines,  tranqui- 
lizers and  sleep  hypnotics.  Amphetamines 
may  be  prescribed  by  physicians  for  obes- 
ity or  lethargy,  the  patient  enjoys  the 
stimulation  derived  and  continues  to  use 
the  drug  if  the  physician  is  not  alert  in 
regulating  and  curbing  the  supply.  Some 
common  tranquilizers  are  adclictive  and 
present  withdrawal  problems.  A number 
of  these  drugs  potentiate  each  other  and 
alcohol  to  the  extent  that  it  has  become 
a growing  method  for  suicide— the  most 
used  method  with  women. 


in  mounting  drug  abuse 

• Drug  addiction  is  contagious  and  epi- 
demic. Users  infect  others.  In  Sweden,  ad- 
dicts are  doubling  in  number  every  30 
months  except  for  one  period  when  the 
government  relaxed  restrictions  and  the 
number  doubled  in  12  months. 

• Lumping  marijuana  with  other  drugs 
contributes  to  present  legal  problems  of 
enforcement.  Marijuana  does  not  appear 
to  be  physically  addictive  but  creates  psy- 
chological dependence,  although  the  ex- 
tent is  difficult  to  gauge.  It  does  not  appear 
to  incite  the  user  to  violence,  as  ampheta- 
mines often  do. 

• The  number  of  prescriptions  written 
for  minor  tranquilizers  and  barbiturates 
where  not  really  indicated  should  concern 
the  medical  profession  and  an  all-out  ef- 
fort should  be  made  to  reduce  unneeded 
family  stockpiles  of  these  medications.  Chil- 
dren may  be  tempted  to  experiment  with 
drugs  found  in  the  family  medicine  cabinet. 

• Not  only  the  patient,  but  the  physician 
can  be  addicted,  since  the  physician  be- 
cause of  his  training  and  experience  is  sus- 
ceptible to  the  taking  of  drugs  for  a trouble- 
some condition.  The  physician  must  be 
sure,  in  prescribing  a tranquilizer,  that  the 
patient’s  anxiety  is  at  a level  to  warrant  the 
use  of  a drug.  He  must  be  sure  to  regulate 
the  supply  and  not  continue  it  indefinitely. 

Chairman  of  the  symposium  was  Jerome 
Jaffe,  M.  D.,  associate  professor.  Depart- 
ment of  Psychiatry,  University  of  Chicago. 
His  major  interest  is  in  the  use  and  abuse 
of  psychoactive  drugs,  particularly  the 
biological  and  sociological  aspects. 


One  sex  could  collapse  our  culture 

Why  should  this  country's  future  be  influenced  by  unisex?  Our  survival 
quotient  reflects  the  capacity  to  adapt;  and  adaptation  mirrors  the  strength 
of  our  feelings  of  personal  identity.  Central  to  anyone's  sense  of  personal 
identity  is  his  or  her  awareness  of  sex.  A man  with  a confused  notion  of 
masculinity,  and  a woman  with  an  uncertain  feeling  of  femininity,  is  likely 
to  possess  a relatively  unhealthy  and  ineffective  concept  of  personal  iden- 
tity. Of  the  more  than  2,000  cultures  about  which  we  have  some  informa- 
tion, every  single  one  of  the  approximately  fifty-five  with  blurred  sex  roles 
and  feelings  of  personal  identity  collapsed  in  a few  generations. 

Man  may  still  propose,  God  dispose— but  history  imposes.  Perhaps  the 
most  significant  lesson  of  the  past  for  our  age  of  unisex  is  that  no  culture 
characterized  by  a similar  blurring  has  proved  viable.  (Charles  Winick, 
Ph.D.:  Sex  and  Society:  Unisex  in  America.  Medical  Opinion  & Review 
(Sept.)  1970,  pages  62-63,  65.) 


554 


Illinois  Medical  Journal 


Rx  Product 
Index 


Achrocidin  501 

Achrostatin  - 561 

Lederle  Laboratories 

Antrocol  ..479 

Win.  Poythress  & Co.,  Inc. 

Aventyl  HCL  486-488 

Eli  Lilly  & Company 

Dicarbosil  560 

Arch  Laboratories 

Dimetapp/Phenaphen  549-550 

A.  H.  Robins  Co.,  Inc. 

Ilosone  502 

Eli  Lilly  and  Company 

Kinesed  484-485 

Stuart  Pharmaceuticals  Div. 

Atlas  Chemical  Industries,  Inc. 

Librium 492-493 

Roche  Laboratories 

Lomotil  2nd  Cover 

G.  D.  Searle  & Co. 

Mucomyst  476-477 

Mead  Johnson  Laboratories 

Mylanta  473 

Stuart  Pharmaceuticals  Div. 

Atlas  Chemical  Industries,  Inc. 

Neosporin  Ointment  483 

Burroughs  Wellcome  & Co. 

Neo-Synephrine  .474 

Winthrop  Laboratories 

Orenzyme/AVC  555-556 

National  Drug  Company 

Senokot  557,  3rd  Cover 

Purdue  Frederick  Co. 

Silain-Gel  490-491 

A.  H.  Robins  Co.,  Inc. 

Sinequan  495-498 

Pfizer  Laboratories  Div. 

Pfizer  Inc. 

Tepanil/Quinamm  481-482 

National  Drug  Co. 

Valium  Back  Cover 

Roche  Laboratories 


In  the  colon . 

SENOKOT  Tablets/ Granules,  a standardized, 
natural  vegetable  derivative,  offer  a gentle, 
physiologic  approach  to  laxation  which  is 
virtually  colon  specific  — acting  not  by  irritation 
of  colonic  mucosa  but  through  reproducible 
neuroperistaltic  stimulation  mediated  through 
Auerbach’s  motor  plexus. 

The  current  theory  is  that  glycosides  (laxa- 
tive principles  of  the  senna  plant)  are  transported 
to  the  colon  where  they  are  changed  to  aglycones 
that  stimulate  Auerbach’s  plexus  to  induce 
peristalsis. 

This  means  your  patient  can  enjoy  the 
benefits  of  the  gentle  laxative  action  of  SENOKOT 
preparations  which  are  generally  predictable, 
reproducible  and  effective. 

At  proper  dosage  levels,  SENOKOT  Tablets/ 
Granules  are  generally  free  of  side  effects. 

When  taken  at  bedtime,  SENOKOT  Tablets/ 
Granules  usually  induce  comfortable  evacuation 
in  the  morning.  pdf.ioosto 

Senokot 

(standardized  senna  concentrate) 

Tablets/Granules 


Purdue  Frederick 

) COPYRIGHT  1 9 70,  THE  PURDUE  FREDERICK  COMPANY,  YONKERS,  N.Y.  10701 


for  November,  1970 


557 


Dedicated  to  Progressive  Psychiatry 
and  Oriented  to  Short  Term 
Hospitalization  and  Treatment 


"MAN  IS  NOT  SOUL  OR  BODY,  BUT  THESE 
TWO  SUBSTANCES  INMOSTLY  UNITED" 


Psychological  and  Physiological  ther- 
apies for  the  neuroses,  psychoses  and 
psychosomatic  disorders,  with  special 
emphasis  on  INSULIN  DEEP  COMA 
THERAPY  for  the  schizophrenias  and 
the  newly  developed  INDOKLON 
THERAPY  for  the  depressions. 

FOR  ADOLESCENTS:  Quality  care  with 
specialized  programs  including  ac- 
credited schooling. 

Phone:  312-878-9700 
4840  NORTH  MARINE  DRIVE 
CHICAGO,  ILLINOIS  60640 

J.  Dennis  Freund,  M.D.,  Medical  Director 


THE  VIEW  BOX 

( Continued  from  page  508) 

DIAGNOSIS:  3.  Steak  eaters  disease 
Physiologic  narrowing  of  the  esophagus 
occurs  at  three  points  of  some  clinical  sig- 
nificance, particularly  in  patients  who  have 
ingested  foreign  objects.  Coins  are  likely  to 
stick  above  the  level  of  the  manubrium 
sterni.  Other  objects  may  lodge  at  the  level 
of  the  aortic  arch  or  bifurcation  of  the  tra- 
chea, where  strictures  also  are  particularly 
likely  to  form.  The  third  point  of  physio- 
logic narrowing  is  located  at  the  diaphragm, 
where  large  chunks  of  meat  or  other  foods 
may  stick  and  fail  to  pass— so-called  “steak 
eater’s  disease.”  Of  incidental  interest  is  a 
form  of  treatment  using  a meat  tenderizer. 
The  patient  drinks  a solution  every  10 
minutes  until  the  meat  fibers  dissolve.  It 
seems  to  be  selective  for  the  steak  and  not 
for  the  esophagus.  However  if  you  are 
doubtful  about  attempting  this,  the  other 
method  of  therapy  is  removal  through  the 
esophagoscope.  The  esophogram  was  nor- 
mal after  passage  of  the  steak  bolus. 


Obituaries 

"''Frederick  P.  Cowdin,  Springfield,  died 
June  3 at  the  age  of  86.  He  was  past  presi- 
dent of  the  Sangamon  County  Medical  So- 
ciety and  a member  of  the  ISMS  Fifty-Year 
Club. 

* William  H.  Haines,  Chicago,  died  Sep- 
tember 16  at  the  age  of  72.  He  was  director 
of  the  Behavior  Clinic  of  the  Cook  County 
Criminal  Court. 

'•'Joseph  G.  Kostrubala,  Kenosha,  Wis- 
consin, died  September  30  at  the  age  of  67. 
'■'Harold  A.  Swaiiberg,  Quincy,  died  in 
September  at  the  age  of  78.  He  was  a 
founder  of  the  American  Medical  Writers 
Association  and  a member  of  the  ISMS 
Fifty-Year  Club.  He  was  past  president  and 
past  secretary  of  the  Adams  County  Medi- 
cal Society. 

'•'Earle  H.  Thomas,  Lake  Wales,  Fla.,  died 
September  16.  He  was  well  known  through- 
out the  United  States  for  his  work  in  oral 
surgery  and  his  numerous  scientific  articles. 
Fie  was  a member  of  the  ISMS  Fifty-Year 
Club. 

*Indicates  member  of  Illinois  State  Medical  Society 


558 


Illinois  Medical  Journal 


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will  be  fought. 

Improve  Legal  Climate 

Company  will  retain  outstanding  defense 
counsels  who  are  experts  in  professional- 
liability  cases. 

Provide  Market  Stability 

Company  will  maintain  an  available  market. 
Participation  by  the  members  is  needed  to 
assure  this  market. 

Keep  Members  Informed 

Company  will  tell  members  how  to  prevent 
claims  . . . keep  them  aware  of  latest  legal 
developments  in  malpractice  field. 

ISMS  Supervision  And  Control 

Premiums  to  reflect  only  the  loss  experience  of  ISMS.  All  questionable 
underwriting  cases  to  be  reviewed  by  ISMS,  a unique  feature 


FOR  INFORMATION,  ASSISTANCE  & DETAILS  CONTACT  ADMINISTRATORS: 


9933  N.  Lawler  Avenue 
Skokie,  Illinois  60076 
Phone:  312-679-1000 


MOVING  SOON? 


Let  Your  IMJ  Move  With  You! 


The  Post  Office  will  not  forward  the  Illinois  Medical  Journal  from  your 
old  address.  Make  certain  you  keep  getting  your  Journal  by  filling  in 
and  mailing  the  form  below  to:  The  Illinois  Medical  Journal,  360  N. 
Michigan  Ave.,  Chicago,  Illinois  60601.  Do  it  now! 


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(send  IMJ  here) 


(number) 

(city) 

(number) 

(city) 


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I 


for  November,  1970 


559 


Dicarbosil 

ANTACID 


Your  ulcer  patients  and 
others  will  appreciate  it. 
Specify  DICARBOSIL  144  s- 
144  tablets  in  12  rolls. 


ARCH  LABORATORIES 

I 319  South  Fourth  Street.  St.  Louis.  Missouri  63102 


COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 

STARTING  DATES— 1970 

SPECIALTY  REVIEW  COURSE  IN  SURGERY,  PART  II.  Nov.  30 
SPECIALTY  REVIEW  COURSE  IN  MEDICINE,  PART  II,  Nov.  16 
SPECIALTY  REVIEW  COURSE  IN  ORTHOPEDICS,  Nov.  16  & 
Dec.  7 

PROCTOSCOPY  & VARICOSE  VEINS,  One  Week,  December  14 
SYMPOSIUM  ON  SHOCK,  Two  Days,  December  18 
BASIC  OBSTETRICS,  One  Week,  November  16 
BASIC  GYNECOLOGY,  One  Week,  November  30 
SURGICAL  & RADIATION  THERAPY  OE  GYNE.  MALIGNAN- 
CIES, Nov.  30 

VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  Dec.  14 
UROLOGY  EOR  GENERAL  PRACTITIONERS,  Two  Days.  Nov.  19 
ADVANCES  IN  MEDICINE,  One  Week,  November  30 
GENERAL  PEDIATRICS,  One  Week,  November  30 
CLINICAL  NEUROLOGY,  One  Week.  December  7 
RADIOISOTOPES,  One  or  Two  Weeks,  Request  Dates 
INHALATION  & REGIONAL  ANESTHESIA,  Request  Dales 
Informal  Clinical  Courses  in  Subspecialties,  Request  Dates 

Information  concerning  numerous  other 
continuation  courses  available  upon  request. 

TEACHING  FACULTY 


Attending  Staff  of 
Cook  County  Hospital 

Address: 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 


Surgical  Grand 
Rounds 

(Continued  from  page  513) 

and,  especially,  for  this  kind  of  tumor.  She’s 
got  a total  resection. 

Dr.  Beal:  As  I recall,  this  is  one  of  the 
tumors  in  which  you  were  satisfied  to  re- 
move part  of  the  tumor  in  order  to  lessen 
the  morbidity  and  the  mortality. 

Dr.  Raimondi:  This  is  correct  and  Dandy's 
approach  to  it  was  .simply  to  gut  the  tumor: 
he’d  open  the  capside  and  gut  the  inside 
and  then  he’d  leave  the  tumor  there  be- 
cause, in  taking  the  tumor  out,  the  mortal- 
ity and  morbidity  were,  really  and  truly, 
prohibitive. 

Dr.  Beal:  So  this  is  another  advance  by 
the  method  that  you  outlined;  that  your 
surgical  approach  now  is  one  that  is  more 
or  less  complete. 

Dr.  Raimondi:  Without  any  element  of 
bluster,  I think,  if  you  look  across  the 
land,  you  will  find  that  now  a postoperative 
death  in  an  acoustic  neurinoma  is  really 
looked  on  with  considerable  criticism.  1 
suspect  if  you  get  a couple  of  them,  then 
tlie  otologists  aren’t  going  to  be  working 
with  you  anymore,  because  they’ve  got  a 
much  better  morbidity  and  mortality  com- 
ing right  through  the  ear. 

Dr.  Kerth:  The  postoperative  mortality  is 
still  between  5 and  10%,  but  this  is  true 
only  for  large  tumors.  We  feel  that  one 
should  attempt  complete  removal  at  the 
time  of  initial  surgery.  Doctory  Dandy  at 
one  time  advocated  incomplete  removal,  but 
a long  term  follow-up  of  his  patients  showed 
that  they  frequently  came  to  secondary 
surgery  and  the  mortality  at  that  time  was 
very  high.  M 


Film  Revieivs 

"Diagnosis  in  Clinical  Disorders  of  Cal- 
cium and  Bone  Metabolism"  is  a two-part, 
16mm,  sound  film  in  which  parathyroid 
diseases,  including  primary  hyperparathy- 
roidism, parathyroid  dysfunction  in  renal 
failure,  and  hypoparathyroidism  are  dis- 
cussed using  slides  and  charts.  Both  films 
can  be  obtained  from:  National  Medical 
Audio-visual  Center  (Annex),  Station  K, 
Atlanta,  Ga.  30324. 


560 


Illinois  Medical  Journal 


Illinois  Medical  Journal 

volume  138,  number  6 december,  1970 

' 


Editor  

Managing  Editor  

Editorial  Assistant  

Advertising  Manager  ... 
Executive  Administrator 


Theodore  R.  Van  Dellen,  M.D. 

Richard  A.  Ott 

Michaelyn  Sloan 

John  A.  Kinney 

Roger  N.  White 


CONTENTS 


ILLINOIS  STATE 
MEDICAL  SOCIETY 

360  N.  Michigan  Ave.,  Chicago^  60601 


OFFICERS 

J.  Ernest  Breed,  President 
55  East  Washington  Street,  Chicago  60602 
L.  T.  Fruin,  President-Elect 
5 Citizen's  Square,  Normal,  61761 
George  C.  Shropshear,  1st  Vice-President 
1525  East  53rd  Street,  Chicago,  60615 
C.  J.  Jannings,  III,  2nd  Vice-President 
101  East  Center  Street,  Fairfield,  62837 
Jacob  E.  Reisch,  Secretary-Treasurer 

1129  South  2nd  Street,  Springfield  62704 
Paul  W.  Sunderland,  Speaker 

214  North  Sangamon  St.,  Gibson  City,  60936 
Andrew  J.  Brislen,  Vice-Speaker 
6060  South  Drexel  Blvd.,  Chicago  60637 
Willard  C.  Scrivner,  Chairman  of  the  Board 
4601  State  Street,  East  St.  Louis,  62205 


TRUSTEES 


ABSTRACTS  OF  BOARD  ACTIONS  

CLINICAL  ARTICLES 

Lumbar  hernia— An  instance  reported 

R.  H.  Musick,  M.D.  and  Stephen  E.  Schubert,  M.D 

Hemodialysis  1970— Medical  progress 

George  Ditnea,  M.B.,  M.R.C.P 

SURGICAL  GRAND  ROUNDS 

Mid-gut  volvulus  with  malrotation 

SPECIAL  ARTICLES 

The  medical  student,  the  public,  and  medical  care 

Cecil  G.  Sheps,  M.D.,  M.P.H 


Joseph  L.  Bordenave,  1st  District  (1971) 

1665  South  Street,  Geneva,  60134 
William  A.  McNichols,  Jr.,  2nd  District  (1971) 
101  West  First  Street,  Dixon,  61021 
. Fredric  D,  Lake,  3rd  District  (1972) 

1041  Michigan  Avenue,  Evanston,  60202 
James  B.  Hartney,  3rd  District  (1973) 

410  Lake  Street,  Oak  Park,  60302 
Frank  J.  JIrka,  3rd  District  (1971) 

1507  Keystone  Ave.,  River  Forest,  60305 
William  M.  Lees,  3rd  District  (1971) 

6518  N.  Nokomis,  Lincolnwood,  60646 
^ Frederick  E.  WeibS,  3rd  District  (1973) 

15643  Lincoln  Avenue,  Harvey,  60426 
I Warren  W.  Young,  3rd  District  (1972) 

10816  Parnell  Avenue,  Chicago,  60628 
p Fred  Z.  White,  4th  District  (1973) 

723  North  Second  St.,  Chilllcothe,  61523 
i A.  Edward  Livingston,  5th  District  (1973) 

219  North  Main,  Bloomington,  61701 
i J.  Mather  Pfeiffenberger,  6 District  (1972) 

! State  & Wall  Streets,  Alton,  62002 
' Arthur  F.  Goodyear,  7th  District  (1973) 

142  East  Prairie  Avenue,  Decatur,  62523 
Eugene  P.  Johnson,  8th  District  (1973) 

22  West  Main  Street,  Cosey,  62420 
Charles  K.  Wells,  9th  District  (1972) 

117  North  10th  Street,  Mt.  Vernon,  62864 
I Willard  C.  Scrivner,  10th  District  (1972) 

4601  State  Street,  East  St.  Louis,  62205 
Joseph  R.  O'Donnell,  11th  District  (1971) 

[ 444  Park,  Glen  Ellyn,  60137 

Edward  W.  Cannady,  Trustee-at-Large 
J 4601  State  Street,  East  St.  Louis,  62205 


Lhe  plans  of  our  doctors  in  training— Second  article 

I.  Ernest  Breed,  M.D.,  ISMS  president 

CUMULATIVE  INDEX  Volume  138 

FEATURES 

Blue  Shield  Report  

The  President’s  Page  . 

The  View  Box  

New'  Pharmaceutical  Specialties  

Cdinics  lor  Crippled  Children  

Physicians’  Placement  Service  

The  Doctor’s  Library  

Editorials 

Illinois  Medical  Assistants  Association  

Meeting  Memos  . 

Obituaries  

Socio-Economic  News  . 


iMiciofilm  copies  of  current  as  well  as  some  back 
issues  of  the  Illinois  Medical  Journal  may  be 
purchased  from  Xerox  University  Microfilms.  300 
N.  Zeeb  Road.  Ann  Arbor.  Mich.,  48106. 


Reference  Issue  Correction:  AMA  Delegation 


(Cover  story  on  page  5S2) 


..bll 


585 


594 


589 


■598 

602 


-634 


.565 

.573 

.588 

.604 

.606 

.607 

.608 

.609 

.620 

.621 

.621 

.627 

-611 


[ Published  monthly  by  the  Illinois  State  Medical 
I Society.  360  N.  Michigan  Ave..  Chicago.  111.,  60601. 
I Copyright  1970,  The  Illinois  State  Medical  Society. 

[■  Subscription  $5.00  per  year,  in  advance,  postage 

t prepaid,  for  the  United  States,  Cuba.  Puerto  Rico, 
i Philippine  Islands  and  Mexico.  $7.50  per  year  for 
R all  foreign  countries  included  in  the  Universal  Postal 
jfi  Union.  Canada  $5.50  U.S.  Single  current  copies 
U available  at  75c. 

Second  class  postage  paid  at  Chicago,  III.  and  at 
|t  additional  mailing  offices.  When  moving  please  notify 


Journal  office  of  new  address  including  old  mailing 
label  with  notification,  if  possible.  POSTMASTER: 
Send  notice  on  form  No.  3579  to  Illinois  State 
Medical  Society,  360  N.  Michigan  Are.,  Chicago. 
III.  60601. 

Pharmaceutical  advertising  must  be  approved  by 
the  ISMS  Publications  Committee.  Other  advertising 
accepted  after  review  by  Publications  Committee  o- 
Board  of  Trustees.  All  copy  or  plates  must  reach  the 
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Original  articles  will  be  considered  for  publication 
with  the  understanding  that  they  are  contributed  only 
to  the  Illinois  Medical  Journal.  The  ISMS  denies 
responsibility  for  opinions  and  statements  expressed  by 
authors  or  in  excerpts,  other  than  editorial  or  allied 
views  or  statements  which  reflect  the  authoritative 
action  of  the  ISMS  or  of  reports  on  official  actions, 
policies  or  positions.  Views  expressed  by  authors  do 
not  necessarily  represent  those  of  the  Society;  any 
connection  with  official  policies  is  coincidental. 


for  December,  1970 


569 


BLUE  SHIELD 


BLUE  CROSS/BLUE  SHIELD 

Blue  Cross  and  Blue  Shield  have  appointed  and 
are  training  several  physicians  to  serve  as  profes- 
sional consultants.  They  will  meet  with  Utilization 
Review  committees  and  committee  chairmen,  to 
review  their  procedures  and  guidelines,  evaluate 
the  eflfectiveness  of  Utilization  Review,  and  suggest 
ways  to  improve  when  necessary. 

Utilization  Review  committees,  urged  by  Illinois 
physicians  four  years  before  Medicare,  became  in- 
creasingly important  with  the  advent  of  Medicare 
because  such  committees  were  made  a condition  of 
participation  for  hospitals.  They  were  also  required 
for  accreditation  by  the  Joint  Commission  on  Ac- 
creditation of  Hospitals. 

Blue  Cross  and  Blue  Shield  recognize  the  respon- 
sibilities of  Utilization  Review  committees.  But  we 
also  know  that  some  function  more  effectively  than 
others.  This  may  be  due  to  a variety  of  reasons, 
many  of  which  we  feel  can  be  corrected  with  pro- 
tessional  guidance  and  assistance. 

Representatives  of  Blue  Cross  and  Blue  Shield 
have  continued  to  work  closely  with  members  of 
the  Board  of  Trustees  of  the  Illinois  State  Medical 
Society  to  find  more  economical  ways  to  use  health 
services  and  facilities  without  additional  govern- 
ment intervention.  Last  year  we  met  with  the  Board 
of  Trustees  and  asked  their  help  in  appointing  con- 
sultants to  Blue  Cross  and  Blue  Shield. 

Several  physicians  expressed  a willingness  to 
serve  as  consultants  and  to  help  physicians  conduct 
more  effective  utilization  review  in  local  hospitals. 

Dinner  Workshops  End  for  Chicago  Area 

Blue  Shield  ended  its  annual  series  of  dinner 
workshops  for  medical  assistants  in  the  Chicago 
area  on  November  19  with  our  final  meeting  in  the 
Knickerbocker  Hotel.  This  year,  the  meetings,  held 
on  Wednesday  and  Thursday  nights  from  late  Sep- 
tember on,  were  attended  by  more  than  4,000  medi- 
cal assistants  and  other  invited  guests. 

We  received  many  favorable  comments  on  the 
program,  including  the  slide  presentation  showing 
our  Blue  Shield  Plan  oflBces  and  the  steps  that  are 
taken  in  processing  Medicare  and  Blue  Shield 
claims. 


APPOINT  CONSULTANTS 

We  expect  that  these  consultants  will  be  able  to 
increase  the  efficiency  of  committees.  It  is  equally 
important  that  these  reviews  remain  the  responsi- 
bility of  physicians  rather  than  that  of  non-profes- 
sionals. 

Physicians  interested  in  learning  more  about  the 
consultant  program  may  obtain  information  by  writ- 
ing to: 

Morton  W.  Adler,  M.D. 

Assistant  Medical  Director 
Assistant  Vice  President 
Blue  Cross/Blue  Shield 
222  North  Dearborn  Street 
Chicago,  Illinois  60601 

INCORRECT  PAYMENT? 

Here’s  What  to  Do 

Occasionally,  Blue  Shield  will  issue  an  incorrect 
check.  It  may  be  an  overpayment,  duplicate  pay- 
ment, or  payment  to  the  wrong  physician. 

The  physician  should  not  attempt  to  remedy  the 
situation  by  himself  by  forwarding  an  incorrect 
payment  to  the  other  physician. 

Instead,  the  physician  should  notify  us,  in  writ- 
ing, of  the  error.  Our  address  is; 

Blue  Shield  Plan  of 
Illinois  Medical  Service 
Professional  Relations  Department 
222  North  Dearborn  Avenue 
Chicago,  Illinois  60601 

Please  include  the  check  number,  date,  patient  s 
name,  group  and  subscriber  number  and  date  of 
service. 

If  the  error  is  a duplicate  payment  or  payment  to 
the  wrong  physician,  please  return  the  check  with 
your  letter. 

If  the  error  is  an  overpayment,  we  recommend 
that  you  keep  the  check  until  we  determine  the 
amount  of  the  overpayment.  However,  if  you  wish, 
you  may  return  the  original  check  and  we  will  issue 
you  another  one. 


(This  is  not  an  advertisement) 


ASK  BLUE  SHIELD 


• * • ABOUT  MEDICARE 

Private  Clinics  and  Physician  Groups 

Medical  groups  or  physicians’  clinics  which  have 
agreements  with  individual  staflf  or  member  physi- 
cians to  bill  for  them  should  use  the  SSA-1490, 
Medicare  Request  for  Payment  form. 

The  group  should  inform  us  that  it  will  be  billing 
for  the  physicians,  only  when  it  has  proper  author- 
ization, on  file,  from  each  physician. 

If  charges  are  uniform  for  all  physicians,  services 
furnished  by  different  physicians  for  the  same  pa- 
tient may  be  reported  on  the  same  SSA-1490  form. 
In  this  case,  we  will  assign  one  physician  code 
number  for  the  group  as  a whole. 

Groups  in  the  five  county  area  of  Cook,  Kane, 
Lake,  Will  and  DuPage,  wishing  to  be  assigned 
such  a number,  should  contact  Walter  Livingston, 
Director  of  Professional  Relations,  or  Mrs.  Loretta 
O’Donnell,  Professional  Relations  Representative. 

The  form  should  be  signed  by  an  authorized  rep- 
resentative of  the  group,  who  need  not  be  a physi- 
cian. 

Where  the  charge  for  a procedure  differs  de- 
pending on  the  individual  physician,  the  name  of 
the  physician  should  be  shown,  together  with  the 
description  of  the  procedure  in  Item  7c  of  the  SSA- 
1490.  In  this  case,  individual  codes  will  be  used  for 
each  physician. 

Billing  Patients 

When  You  Accept  Assignment 

Physicians  should  be  reminded  that  if  they  ac- 
cept assignment,  they  agree  to  accept  the  reasonable 
charge  determined  by  Medicare,  and  they  agree 
not  to  bill  the  patient  for  more  than  any  remaining 
deductible  and  20  percent  of  the  reasonable  charge. 
Medicare  will  pay  the  other  80  percent. 

Many  times,  physicians  who  have  accepted  as- 
signment supply  their  patient  with  an  itemized,  non- 
receipted  bill.  Then  the  patient,  unknown  to  the 
physician,  will  submit  his  own  separate  claim  for 
payment.  Since  Medicare  does  not  require  a re- 
ceipted bill  to  pay  the  patient,  it  is  possible  that 
we  will  make  payment  to  the  patient  instead  of  the 
doctor. 

To  avoid  this  problem,  we  urge  physicians  who 
accept  assignment  1)  to  make  sure  any  bill  given 
to  the  patient  shows  clearly  that  the  physician  has 
accepted  assignment,  or  2)  not  to  send  a bill  to 
the  patient  until  after  they  receive  our  payment  and 
can  show  the  patient  the  allowable  charges  and 
balance  remaining. 


MEDICARE: 

What  it  Pays  For 

Physicians  and  their  medical  assistants  often  ask 
questions  about  Medicare’s  coverage.  Though  it  is 
impossible  for  us  to  give  you  a complete  listing  here 
of  all  services  and  goods  covered  by  Part  B,  there 
are  certain  general  guidelines  which  should  answer 
most  questions  physicians  have  about  coverage. 
Part  B of  Medicare  will  help  pay  for: 

1)  Medical  and  surgical  services  performed  by 
a physician  anywhere  in  the  United  States,  e.g., 
in  the  home,  hospital,  clinic,  nursing  home,  etc. 

2 ) Other  services  ordinarily  furnished  in  the  phy- 
sician’s oflBce  and  included  in  his  bill  such  as: 

a)  Diagnostic  tests  and  procedures.  (If  fur- 
nished by  an  independent  laboratory,  the  physi- 
cian must  indicate  the  name  of  the  lab  and 
all  charges  made  on  the  SSA-1490  form.), 

b)  Medical  supplies, 

c)  Services  of  his  office  nurse, 

d ) Drugs  and  biologicals  which  cannot  be 
self-administered. 

Part  B of  Medicare  will  NOT  pay  for: 

1 ) Routine  physical  checkups  ( and  lab  tests  re- 
lated to  them), 

2)  Routine  foot  care  and  treatment  of  flat  feet, 
sprains,  or  partial  dislocations, 

3)  Eye  refractions  and  examinations  for  eye- 
glasses, 

4)  Hearing  examination  for  hearing  aids, 

5)  Immunization  (unless  directly  related  to  an 
injury  or  immediate  risk  of  infection,  e.g.,  anti- 
tetanus shot  given  after  an  injury. 

6)  Papanicolaou  tests,  unless  one  of  the  follow- 
ing conditions  has  been  met: 

a)  Previous  cancer  of  the  cervix,  uterus  or 
vagina  which  has  already  been  tested.  The 
“Pap  smear”  would  be  for  the  purpose  of  follow 
up  care. 

h ) Previous  abnormal  “Pap  smears.” 

c)  Irritation  or  inflammation  of  the  cervix  as 
determined  by  physical  examination. 

d)  Abnormal  vaginal  discharge  or  bleeding. 
For  a more  detailed  explanation  of  covered  bene- 
fits, ask  for  a copy  of  the  “Physicians  Guide  to  Medi- 
care” available  at  your  local  social  security  oflBce, 
or  if  you  live  in  the  five  county  area  of  Gook,  Kane, 
Lake,  Will  and  DuPage,  write  to: 

Professional  Relations  Department 
Blue  Shield  Plan  of 
Illinois  Medical  Service 
222  North  Dearborn  Street 
Ghicago,  Illinois  60601 


(This  is  not  an  advertisement) 


J.  Ernest  Breed 


The 

President’s 

Page 


Innovations  mark  the  Annual  Meeting 


Profound  changes  are  planned  for  the 
Annual  Meeting  of  the  State  Medical  So- 
ciety next  May.  To  begin  with,  the  meet- 
ing place  has  been  changed  to  the  Arling- 
ton Park  Towers  Hotel  in  Arlington 
Heights. 

This  beautiful,  fourteen  story  hotel  over- 
looks the  Arlington  Park  race  track,  a 
c[uarter  of  a mile  away,  and  is  surrotmded 
by  open  spaces.  It  has  a 9 hole,  lighted 
golf  course  on  one  side,  and  ample  free 
parking  space  on  the  other.  The  hotel  is 
easy  to  reach  via  the  Northwest  Toll  Road 
and  lies  about  10  miles  northwest  of  the 
O’Hare  Airport.  A courtesy  shuttle  bus 
travels  between  the  airport  and  the  hotel. 

Instead  of  a crowded,  noisy,  old  build- 
ing, we  will  be  housed  in  a new,  clean 
exotic  hotel  with  superb  facilities,  includ- 
ing a night  club,  theatre,  swimming  pool 
and  several  fine  restaurants. 

The  hotel  has  ample  meeting  rooms  for 
our  banquets,  exhibits  and  House  of  Dele- 
gates meeting.  The  sleeping  rooms  are  all 
air  conditioned,  roomy  and  beautifully  dec- 
orated. 

In  addition  to  the  regular  scientific  pro- 
grams arranged  by  the  specialty  societies, 
there  will  be  36  small  classes  of  20  to  30 
doctors  on  many  scientific  subjects,  lasting 
from  8:30  a.m.  to  10:00  a.m.  A list  of  these 
classes  and  the  professors  wall  soon  be  sent 
to  you  and  those  who  wish  to  attend  must 
sign  up  in  advance.  Credits  will  be  given 
toward  the  AMA  Continuing  Education 


Award,  and  the  Academy  of  Family  Prac- 
tice membership  requirements. 

There  will  be  a large  self-testing  section, 
capable  of  handling  300  physicians  a day, 
where  you  may  test  your  knowledge  against 
the  computer.  You,  alone,  receive  your 
score.  Just  for  fun,  see  how  you  rate. 

Our  ladies  will  receive  special  attention. 
There  will  be  special  programs,  luncheons, 
style  shows,  theatre  parties,  even  perhaps 
a golf  tournament.  There  will  also  be  fre- 
(|uent  btises  to  Chicago’s  Loop  and  to  the 
w'ell  known  shopping  centers  of  the  north- 
west and  north  areas. 

One  of  the  chief  advantages  in  having 
the  membership  housed  in  one  hotel  is 
that  it  provides  the  opportunity  to  become 
acqtiainted  with  your  colleagues  from  dif- 
ferent parts  of  the  state.  You  will  be  sur- 
prised at  how  much  you  have  in  common. 

Visit  the  House  of  Delegates  and  the  ref- 
erence committee  meetings,  and  let  your 
voice  be  heard.  These  are  trying  times  for 
the  medical  profession,  but  unless  you  take 
part  in  the  deliberations  you  cannot  com- 
plain if  you  don’t  approve  of  the  actions 
taken  by  your  Society. 

Make  your  reservations  early  and  come 
to  the  Illinois  State  Medical  Society  meet- 
ing at  the  Arlington  Park  Towers  Hotel 
next  May. 


for  December,  1970 


373 


PUBLISHED  TO  REPLACE  A PREVIOUS 
ADVERTISEMENT  WHICH  THE  FOOD  AND  DRUG 
ADMINISTRATION  CONSIDERED  MISLEADING 


The  Food  and  Drug  Administration  has  requested  that  we  bring  to  your  attention 
a recent  promotional  campaign  for  Garamycin  Injectable  (gentamicin  sulfate)  which 
featured  a nationwide  in-vitro  hospital  survey  involving  a comparison  of 
sensitivity  patterns  of  Garamycin  Injectable  and  seven  other  antibiotics. 


The  FDA  considers  the  advertising  misleading  in  several  respects  such  as: 


The  in-vitro  chart  contained  in  the  ads,  which  compared  Garamycin  Injectable 
with  seven  other  antibiotics,  implied  that  Garamycin  Injectable  is  clinically  more 
effective  than  the  seven  other  compared  antibiotics.  THE  FACTS  ARE  (1 ) THAT 
DIRECT  EXTRAPOLATION  OF  NONCLINICAL  FINDINGS  TO  CLINICAL 
EFFECTIVENESS  IS  UNWARRANTED,  AND  (2)  THAT  THE  ADVERTISED 
IN-VITRO  COMPARISONS  DO  NOT  CONSTITUTE  A VALID  BASIS  FOR 
SUGGESTING  THAT  GARAMYCIN  INJECTABLE  HAS  GREATER  CLINICAL 
EFFECTIVENESS  THAN  THE  COMPARED  ANTIBIOTICS. 


The  in-vitro  chart  and  information  contained  under  the  ad  heading,  "Indications" 
presented  in-vitro  data  results  in  such  a way  as  to  imply  that  the  drug  is  indicated 
for  Gram-positive  bacteria,  such  as  Staphylococcus  aureus.  GARAMYCIN  INJECTABLE 
IS  NOT  APPROVED  FOR  INFECTIONS  DUE  TO  ANY  GRAM-POSITIVE 
ORGANISMS. 


We  emphasize  that  Garamycin  Injectable  is  approved  for  use  only  in  infections 
due  to  susceptible  strains  of  gram-negative  bacteria,  including  Pseudomonas 
aeruginosa,  and  species  of  indole-positive  and  indole-  negative  Proteus, 
Escherichia  coli,  and  Klebsiella-Aerobacter. 


74 


Illinois  Medical  Journal 


Abstracts  Of  Board  Actions 

Board  of  Trustees  Meeting 

October  24-26,  1970 

Augustine’s,  Belleville 

These  abstracts  are  published  so  that  members  of  the  Illinois  State  Medical  Society  may 
keep  advised  of  the  actions  of  the  Board  of  Trustees.  It  covers  only  major  actions  and  is 
not  intended  as  a detailed  report.  Full  minutes  of  the  meetings  are  available  upon  any 
member’s  request  to  the  headquarters  office  of  the  ISMS. 

Reports  of  Officers  and  Others 

Reports  from  the  officers  covered  numerous  matters  in  health 
care  delivery,  medical  education  and  manpower,  indicating  a keen 
awareness  of  problems  in  these  areas. 

President  Breed  reported  on  further  negotiations  with  Dr. 
George  Miller  at  the  University  of  Illinois  College  of  Medicine, 
to  conduct  a self-examination  project  at  the  1971  Annual  Meet- 
ing. Approximately  300  physicians  will  be  tested  on  each  of  three 
days,  with  confidential  scores  expected  to  reveal  to  the  indi- 
viduals the  extent  of  his  need  for  refresher  training.  The  Board 
acted  to  approve  the  project  in  principle  and  authorized  its  re- 
ferral to  the  Educational  and  Scientific  Foundation  for  funding 
after  final  negotiation  on  costs. 

Dr.  Fruin,  President-Elect,  reported  on  his  attendance  at  the 
Annual  Meeting  of  the  Illinois  Hospital  Association  at  which 
hospital-based  capitation  programs  of  health  care  delivery  re- 
ceived much  attention.  He  expressed  concern  over  the  future  role 
of  the  physician  in  such  programs.  Dr.  O'Donnell  expressed  simi- 
lar concern  after  attending  a meeting  in  Lincoln  at  which  the 
local  hospital  was  engaged  in  plans  to  create  additional  hos- 
pital-based physicians. 

Dr.  Tannings,  Second  Vice-President,  spoke  of  the  physician 
shortage  as  being  the  number  one  concern  of  downstate  rural 
physicians.  He  referred  to  numerous  shortcomings  of  governmen- 
tal and  other  health  care  programs  and  interferences  in  the  prac- 
tice of  medicine.  Dr.  Tannings  concluded  by  stating  that  in  his 
opinion  and  that  of  some  colleagues,  organized  medicine  has 
sold  out  to  the  Federal  government  by  going  along  with  all  that 
is  suggested. 

In  reporting  for  the  Finance  Committee,  Dr.  Pf eiff enberger , 
Chairman,  indicated  that  expenditures  were  in  line  with  income 
and  within  the  budget  as  of  the  September  30  Financial  Statement. 
The  1971  budget  will  be  developed  early  in  December  for  Tanuary 
presentation  to  the  Board. 

Dr.  Reisch,  Secretary-Treasurer,  reported  on  membership  mat- 
ters and  commented  upon  the  Leadership  Conference  on  Health 
Maintenance  Organizations  and  Foundations  for  Medical  Care,  to 
be  held  in  Chicago  on  Sunday,  November  15.  Early  indications  are 
that  attendance  will  be  very  large.  He  further  reported  great 
interest  in  the  physician  liability  program  being  presented  on 
the  President's  Tour. 

Dr.  Sunderland,  Speaker  of  the  House,  indicated  plans  to  name 
Reference  Committee  appointments  for  the  1971  Annual  Meeting 
at  the  time  of  the  Tanuary  Board  meeting.  Trustees  were  asked 
to  assist  the  county  societies  to  name  their  delegates  at  an 
early  date. 


for  December,  1970 


577 


Dr.  Scrivner,  Chairman  of  the  Board,  reported  on  the  October 
19  meeting  between  Governor  Ogilvie  and  representatives  of  the 
ISMS.  A sense  of  declaration  was  sought  from  the  Governor  as  to 
the  administration's  goals  and  plans  for  health.  It  was  found 
that  the  Governor  was  quite  well  versed  on  medical  education, 
delivery  of  health  care,  pollution  and  other  matters.  The  ISMS 
was  invited  to  continue  its  input  through  the  usual  channels  and 
to  seek  further  conferences  with  the  Governor  on  problems  which 
needed  his  immediate  attention. 

Relative  Value  Study 

A surprising  number  of  requests  continue  to  be  received  from 
Illinois  physicians  for  copies  of  the  Illinois  Relative  Value 
Study.  This  booklet,  originally  developed  in  the  early  1960s 
and  revised  slightly  in  1963,  has  been  reprinted  twice.  Improve- 
ments and  refinements  made  by  the  California  Medical  Associa- 
tion in  their  RVS  recommends  its  use  in  preference  to  the  Illi- 
nois documents.  The  Illinois  RVS  will  not  be  reprinted  and  mem- 
bers desiring  to  use  a relative  value  study  will  be  advised  to 
obtain  a copy  of  the  new  California  RVS. 

Physician's  Assistants 

The  popularity  of  establishing,  by  law,  a new  category  of 
health  worker  to  be  known  as  a physician’s  assistant,  was  noted. 
The  ISMS  Committee  on  Allied  Health  Education  was  directed  to 
increase  the  tempo  of  its  activity  in  this  area,  looking  toward 
legislation  which  would  provide  some  form  of  recognition  of 
these  persons  as  members  of  the  health  team.  It  is  conceived 
that  such  persons  would  be  supervised  and  directed  by  the  physi- 
cian in  accordance  with  the  needs  as  determined  by  the  physician. 

Regional  Medical  Program 

Questions  were  raised  as  to  whether  or  not  the  Illinois  Reg- 
ional Medical  Program  has  lost  sight  of  its  original  objective 
for  developing  programs  to  combat  heart,  cancer,  stroke,  kid- 
ney and  related  diseases,  as  IRMP  appears  to  have  assumed  a role 
in  health  care  delivery  which  was  excluded  from  the  original 
legislation.  The  Board  authorized  appointment  of  a committee 
to  meet  with  representatives  of  IRMP  to  discuss  this  matter. 

Anti-Substitution  Restrictions  on  Pharmacists 

The  Illinois  Board  of  Pharmacy,  which  administers  the  Illinois 
Pharmacy  Practice  Act,  recently  modified  its  enforcement  rules 
with  respect  to  substitution  of  drugs  as  a cause  for  revocation 
of  license.  Heretofore,  a pharmacist  jeopardised  his  license 
by  substituting,  without  prior  approval,  when  a brand  name  was 
specified.  The  rules  now  provide  that  the  pharmacist  is  in  jeop- 
ardy only  when  the  substitution  involves  a drug  which  is  "not 
of  therapeutic  equivalence." 

The  American  Pharmaceutical  Association  is  on  record  as  favor- 
ing repeal  of  state  anti-substitution  laws.  The  Illinois  Phar- 
maceutical Association  has  not  formally  acted  but  plans  a meet- 
ing next  spring  to  decide  whether  or  not  the  Association  should 
launch  a campaign  to  abolish  the  law. 

Acting  on  the  recommendation  of  the  Council  on  Legislation  and 
Public  Affairs,  the  Board  of  Trustees  adopted  the  concept  of 

(Continued  on  page  612) 


578 


Illinois  Medical  Journal 


deaj*  the  tract 
with  the 


Robitussin  Line 


The  coughing  season  is  here  again.  Time  to  rely 
on  the  four  Robitussins  and  Cough  Calmers  to 
help  clear  the  lower  respiratory  tract.  All  contain 
glyceryl  guaiacolate,  the  efficient  expectorant  that 
works  systemically  to  help  increase  the  output  of 
lower  respiratory  tract  fluid.  The  enhanced  flow  of 
less  viscid  secretions  soothes  the  tracheobron- 
chial mucosa,  promotes  ciliary  action,  and  makes 
thick,  inspissated  mucus  less  viscid  and  easier  to 
raise.  Available  on  your  prescription  or  recom- 
mendation. 

For  coughs  of  colds  and  "flu” 

Robitussin 

Each  5 cc.  contains: 

Glyceryl  guaiacolate 100.0  mg. 

Alcohol,  3.5% 


Non-narcotic  for  6-8  hr.  cough  control 

Robitussin-DM^ 


Each  5 cc.  contains: 

Glyceryl  guaiacolate 100.0  mg. 

Dextromethorphan 

hydrobromide  15.0  mg. 

Alcohol,  1 .4% 


Clears  sinuses  and  nasal 
stuffiness  as  it  relieves  cough 

Robitussin-PE® 

Each  5 cc.  contains: 

Glyceryl  guaiacolate 100.0  mg. 

Phenylephrine  hydrochloride  10.0  mg. 

Alcohol,  1.4% 


For  unproductive  allergic  coughs 

Robitussin  A-C® 


Each  5 cc.  contains: 

Glyceryl  guaiacolate 100.0  mg. 

Pheniramine  maleate 7.5  mg. 

Codeine  phosphate 10.0  mg. 


(warning:  may  be  habit  forming) 
Alcohol,  3.5% 


Robitussin-DM  in  solid  form 
for  "coughs  on  the  go” 

Cough  Calmers™ 

Each  Cough  Calmer  contains: 


Glyceryl  guaiacolate 50.0  mg 

Dextromethorphan 

hydrobromide  7.5  mg 


Select  the  Robitussin‘^“Clear-T ract”  Formulation  That  T reats 
Your  Patient’s  Individual  Coughing  Needs: 

Robitussin- 

extra 

benefit 

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Keep  this  handy  chart  as  a guide  in  selecting  the  formula  that 
provides  the  extra  benefits  you  want  for  your  patient. 

chart 

Cough 

Suppressant  Antihistamine 

Long-Acting 
(6-8  hours) 

Nasal,  Sinus 
Decongestant 

Non-Narcotic 

ROBITUSSIN® 

m 

ROBITUSSIN  A-C® 

m m 

ROBITUSSIN-DM® 

m 

m 

m 

ROBITUSSIN-PE® 

m 

COUGH  CALMERS™ 

Q 

B 

B 

A.  H.  Robins  Company,  Richmond,  Va.  23220 


/I'H'DOBINS 


Control  of  hyaline  membrane  disease 
Proved  effective  by  estrogen  injections 


Injections  of  sex  hormones  for  premature  infants  may  be  the  answer  to 
controlling  hyaline  membrane  disease,  according  to  a report  in  a recent 
issue  of  The  Journal  of  Reproductive  Medicine,  published  by  The  University 
of  Chicago. 

Treating  newborn  infants  with  estrogen  already  has  proved  effective 
in  eliminating  mortality  resulting  from  this  deadly  lung  disease. 

The  report  was  made  by  Dr.  Douglas  R.  Shanklin  of  The  University 
of  Chicago  and  Dr.  S.  L.  Wolfson  of  the  University  of  Florida,  Gainesville. 

The  Journal  of  Reproductive  Medicine  is  the  periodical  of  the  American 
Academy  of  Reproductive  Medicine. 

Dr.  Shanklin  is  Professor  of  Pathology  and  of  Obstetrics  and  Gynecology 
in  the  Division  of  the  Biological  Sciences  and  The  Pritzker  School  of  Medi- 
cine at  The  University  of  Chicago. 

Dr.  Wolfson  is  Clinical  Associate  in  Pediatrics  at  the  University  of 
Florida  and  Teaching  Chief  of  Pediatrics  at  Tampa,  Florida,  General  Hospital. 

"A  possible  role  for  estrogenic  substances  or  a sex  hormone  factor  in 
the  pathogenesis  of  hyaline  membrane  disease  was  derived  from  the 
highly  significant  difference  in  the  incidence  of  fatal  cases  between  male 
and  female  infants,"  they  said. 

The  researchers  found  that  more  male  infants  than  females  die  from 
the  disease,  a deadly  pulmonary  disorder  which  affects  an  infant's 
lungs  and  causes  asphyxiation  when  a protein  membrane  seals  off  the 
air  sacs.  Each  year,  the  disorder  claims  the  lives  of  more  than  25,000  pre- 
mature and  newborn  babies. 

As  a result  of  their  research.  Dr.  Shanklin  and  Dr.  Wolfson  developed 
the  concept  that  "premature  infants  lack  exposure  in  time  to  estrogens  and 
that  a large  dose  might  overcome  some  of  the  effects  of  this  depriva- 
tion." 

In  clinical  trials  with  infants  it  was  found  that  there  was  a reduction 
to  one-third  of  the  clinical  syndrome  of  respiratory  distress.  Mortality  was 
lessened  for  males  but  was  essentially  unchanged  for  females,  again 
furthering  the  interrelationship  between  the  hormone  and  the  sex  of  the 
infant. 

The  clinical  trials  showed  that  intramuscular  injection  in  the  first 
20  minutes  of  life  eliminated  all  mortality. 

"Less  benefit  followed  injection  in  the  interval  21-40  minutes  and  none  at 
all  after  40  minutes  after  birth." 

The  physicians  call  for  future  trials  of  the  estrogen  substance  administer- 
ed at  the  earliest  possible  moment  following  the  birth  of  premature  infants 
and  experiments  to  determine  the  most  effective  dose. 


ON  THE  COVER 

The  dove  of  peace,  in  abstract  form,  graces  the  cover  of  the  December  IMJ— abstract  because 
that  is  the  way  the  concept  of  peace  appears  today,  amid  a world  torn  by  wars,  epidemics 
and  starvation.  The  Journal  staff  conveys  its  "Season's  Greetings"  to  you  and  presents  you 
with  a review  of  the  past  year  in  medicine  with  George  Dunea,  M.B.,  AA.R.C.P.'s  article,  "Hemo- 
dialysis 1970,"  and  Cecil  G.  Sheps,  M.P.H.  M.D.'s  commencement  address  at  the  Chicago 
Medical  School. 


582 


Illinois  Medical  Journal 


volume  138,  number  6 


December,  1970 


Lumbar  bernia 

An  instance  reported 

By  R.  H.  Musick,  M.D.  and  Stephen  E.  Schubert,  M.D./Mendota 


We  are  reporting  a patient  with  a lumbar  hernia  because  of  the 
apparent  infre(|uency  of  its  occurrence.  A review  of  the  literature 
reveals  that  some  180  cases  have  been  reported.  One  large  New 
York  metropolitan  hospital  records  only  two  patients  with  lumbar 
hernia  out  of  250,000  consecutive  admissions.  All  authors  referred 
to  emphasize  that  it  is  a rare  type  of  hernia  to  encounter  in  any 
busy  surgical  practice. 

A majority  of  the  lumbar  hernia  reported  readily  fall  in  one 
of  three  grotips:  (1)  congenital;  (2)  acquired  non-traumatic;  and 
(3)  acquired  traumatic  (from  injuries  or  post-surgical).  It  appears 
that  approximately  one-fourth  fall  in  the  hrst  group,  one-half  in 
tlte  second  and  one-fourth  in  the  third  group. 

Although  our  patient  sustained  trauma  a few  months  prior  to 
the  hnding  of  the  hernia,  we  believe  it  should  be  placed  in  the 
group  of  accjuired  non-traumatic  lumbar  hernias.  We  shall  try  to 
indicate  in  the  operative  findings  our  reasons  for  placing  it  in  this 
classification. 

In  the  lumbar  area  there  are  two  well-dehned  areas  of  potential 
weakness.  One  is  known  as  the  inferior  triangle  of  Petit.  The 
boundaries  of  this  area  are  the  external  oblique  muscle  anteriorly, 
the  latissmus  dorsi  posteriorly  and  the  crest  of  the  ileum  inferiorly. 
The  second  being  the  superior  angle  of  Grynfelt  which  has  as  its 
boundaries  the  twelfth  rib  superiorly,  the  internal  oblique  muscle 
anteriorly  and  the  erector  spinae  posteriorly. 


R.  H.  Musick,  M.D.  (left),  maintains  a private  practice  in 
Meiidota  specializing  in  general  surgery.  He  received  his  M.D. 
from  Northwestern  University  and  served  his  internship  and  resi- 
dency at  Illinois  Central  Hospital,  Chicago.  Stephen  E.  Schu- 
bert, M.D.  (right),  also  does  private  practice  in  Mendota.  A gen- 
eral practitioner.  Dr.  Schubert  received  his  M.D.  from  the  Uni- 
versity of  Illinois  Medical  School,  and  interned  at  Cook  County 
Hospital. 


for  December,  1970 


585 


Case  Report 

The  patient  was  a 71-year-old  white 
woman  who  presented  with  a protruding 
soft  mass  in  the  right  flank  area.  She  com- 
plained of  no  sidojective  symptoms.  A care- 
ful review  of  the  past  history  reveals  only 
that  she  has  had  a moderate  systolic  and 
diastolic  hypertension  for  the  j^ast  ten  years, 
which  has  been  well  controlled  with  hypo- 
tensive drugs.  She  has  had  no  past  surgery, 
or  other  serious  illnesses.  This  patient  was 
in  an  automobile  accident  about  six  months 
prior  to  noting  the  above  finding,  at  which 


and  a resulting  gurgling  sound.  This  lum- 
bar mass  was  noted  more  prominently  with 
the  patient  in  the  sitting  position  and  a 
pulsation  and  an  increase  in  size  noted  on 
coughing  or  laughing.  The  routine  labora- 
tory procedures  showetl  a normal  blood 
picture  and  a normal  urinalysis.  The  blood 
sugar  was  106,  and  the  BUN  20.  An  intra- 
venous jDyelogram  tvas  obtained  showing 
normal  findings  with  no  abnormal  position 
of  the  right  kidney  or  ureter.  A barium 
enema  also  revealed  normal  findings  with 
the  exception  of  the  cecum  and  first  part 


Fig.  1.  Film  of  right  colon  showing  lateral  positioning  of  this  structure  into  hernial  sac. 


time  she  sustained  multiple  rib  fractures 
and  multiple  severe  contusions  on  the  right 
side  of  her  body. 

The  physical  examination  showed  a mod- 
erately obese  woman  appearing  younger 
than  her  chronological  age.  A complete 
physical  examination  revealed  only  positive 
findings  referrable  to  the  right  flank  area. 
As  important  negative  findings  it  should 
be  noted  that  there  are  no  abdominal  scars, 
inguinal  or  umbilical  hernia  and  no  pal- 
pable organs.  Examination  of  the  right  lum- 
bar area  shows  a soft  orange  size  mass 
easily  reduced  in  size  with  light  pressure 


of  the  ascending  colon  projecting  laterally 
beyond  the  subcutaneous  fat  layer  to  au 
extraperitoneal  position.  (Fig.  1) 

This  finding  from  the  barium  enema 
gave  us  the  impression  of  a sliding  hernia 
considering  the  usual  fixation  of  the  cecum 
and  ascending  colon  to  the  posterior  parie- 
tal peritoneum. 

The  operative  procedure  was  carried  out 
under  general  anesthesia  and  the  patient 
placed  in  the  left  lateral  position.  The  table 
was  broken  to  increase  the  space  between 
the  twelfth  rib  and  the  crest  of  the  ileum. 
Au  oblique  incision  was  made  below  the 


580 


Illinois  Medical  Journal 


twelfth  rib  from  about  the  lateral  margin 
of  the  lumbar  muscle  to  a point  just  medial 
to  the  anterior  spine  of  the  ileum.  The  in- 
cision was  carried  through  the  skin  and 
subcutaneous  fat.  An  isolated  mass  of  fatty 
tissue  was  noted  immediately  below  the 
subcutaneous  fat  layer.  This  was  approxi- 
mately 5-6  cm.  in  diameter  and  located  just 
superior  to  the  crest  of  the  ileum.  This 
mass  of  fatty  tissue  could  easily  be  reduced 
into  the  abdomen  through  an  aperture 
which  readily  admitted  three  fingers.  An 
attempt  was  made  to  find  a sac  by  careful 
sharp  and  blunt  dissection  into  this  pro- 
truding fatty  mass. 

A peritoneal  layer  was  soon  encountered 
and  through  this  we  could  easily  see  the 
movement  of  a segment  of  bowel.  We  elect- 
ed not  to  open  the  peritoneum  as  the 
herniation  seemed  to  be  readily  and  com- 
pletely reduced.  This  preperitoneal  mass 
of  fat  was  dissected  from  the  margins  of  the 
aperture  and  partially  removed.  It  was 
noted  that  good  quality  transversalis  fascial 
layers  were  readily  available  and  covdd  be 
appro.ximated  to  completely  close  the  her- 
nial opening  without  undue  tension.  This 
was  done  with  the  approximation  main- 
tained with  interrupted  00  silk  sutures.  The 
hernial  defect  appeared  to  be  adequately 
closed  without  the  need  for  a flap  of  fascia 
lata  as  described  in  some  operative  pro- 
cedures. Drainage  was  provided  for  the  sub- 
cutaneous space  by  the  hemovac  suction 
and  the  wound  closed  by  approximating  the 
subcutaneous  fat  layer  with  interrupted 


plain  00  gut  sutures,  and  the  dermal  mar- 
gins with  interrupted  dermal  00  sutures. 

We  did  not  detect  any  evidence  of  pre- 
viously lacerated  muscle  or  scar  tissue  for- 
mation which  might  be  expected  from  a 
resolved  hematoma.  The  patient  made  a 
good  post  operative  recovery  and  observa- 
tion a few  months  later  indicated  the  her- 
nia is  well  contained. 

Summary 

An  instance  of  a lumbar  hernia  present- 
ing through  Petits  triangle  is  reported. 
Even  though  a history  of  injury  was  present 
the  findings  did  not  indicate  evidence  of 
trauma  in  this  area.  Therefore  we  would 
classify  it  as  an  acquired  non-traumatic 
lumbar  hernia  presenting  through  Petits 
triangle.  ◄ 


References 

1.  Richard  T.  Schackelford,  Surgery  of  the  Ali- 
mentary Tract,  Bickhain-Callander,  1967,  page 
2364. 

2.  E.  Haslett  Frazer,  “A  case  of  lumbo-dorsal 
hernia  with  some  unusual  features,”  The  Med. 
J.  of  Australia,  Vol.  I:  page  60,  January  13, 
1968. 

3.  Benjamin  W.  Butler,  M.D.  and  Alan  D.  Shafer, 
N4.D.,  “Bilateral  Congenital  Lumbar  Hernia,” 
The  Ohio  State  Med.  ].,  Vol.  62:  pages  517-9, 
June,  1966. 

4.  George  B.  Langan  and  Kenneth  J.  Carroll,  “.A 
Grynfelt  Hernia— A Rare  Lumbar  Hernia,” 
Med,  J.  of  Australia,  Vol.  I:  pages  1089-90, 
May  27,  1967. 

5.  Cyril  T.  M.  Cameron,  M.D.,  John  Eufemio, 
M.D.,  and  Thomas  A.  Toosie  M.D.,  “Lumbar 
Hernia— Report  of  a case,”  Med.  J.  of  Austra- 
lia, Vol.  2:  pages  1148-49,  December  10,  1966. 


Birthdays,  anniversaries,  holidays,  ISMS  an- 
nual convention.  May  16-19,  1971 


for  December,  1970 


587 


THE  VIEW  BOX 


By  Leon  Love,  M.D. 

Director,  Department  of  Radiology,  Loyola  University  Hospital 
and  Chairman,  Department  of  Radiology,  Loyola  University 
Stritch  School  of  Medicine 


Fig.  1 


Fig.  2 


This  23-year-old  patient  entered  the  hospital 
with  a history  of  backache,  loss  of  weight,  night 
sweats,  and  fever  which  was  intermittent  in  char- 
acter over  the  past  five  months.  Physical  exami- 
nation revealed  fine  rales  over  both  upper  lung 
fields.  There  was  some  tenderness  over  the  region 
of  the  lower  dorsal  and  upper  lumbar  spine.  A 
PA  chest  film  (Fig.  1)  was  ordered  and  because 
of  its  appearance,  a Bucky  chest  (Fig.  2)  was  re- 
quested. What’s  your  diagnosis? 

1.  Lymphangitic  spread  of  a carcinoma 

2.  Histoplasmosis 

3.  Tuberculosis 

4.  Sarcoidoisis 

(Answer  on  page  639) 


Fig.  3 


588 


Illinois  Medical  Journal 


r#>P5 


V'V 


S'Amj 

f.:;-'A'« 


Surgical  Grand  Rounds  are  held  weekly  on  Saturday  at 
S:00  a.m..  in  the  Offield  Auditorium  at  Passavant  Memorial 
Hospital.  Patient  presentations  from  Passavant,  Chicago 
Wesley  Memorial  and  the  Veterans  Administration  Re- 
search Hospitals  form  the  usual  basis  of  the  discussions. 
This  case  report  was  part  of  the  Surgical  Grand  Rounds  of 
February  2S,  1970,  where  a patient  from  Children’ s Me- 
7iiorial  Hospital  was  presented. 


Mid-gut  volvulus 

witli 

malrotatlon 

Edited  by  John  M.  Beal,  M.D./Chicago 
Case  Report: 

Dr.  Robert  S.  Huebner:  On  January  31, 
1970  a seven-week-old,  white,  male  infant, 
whose  medical  history  had  begun  on  the 
third  day  of  life  when  he  began  to  have 
intermittent  bilious  vomiting  and  progres- 
sive abdominal  distention,  was  admitted  to 
the  Children’s  Memorial  Hospital.  X-rays 
were  taken  at  that  time.  The  upper  G.I. 
series  was  interpreted  as  essentially  normal; 
however,  the  barium  enema  was  said  to 
show  malrotation  of  the  colon.  The  child 
continued  to  vomit.  He  was  subjected  to 
operation  on  the  fifth  day  of  life,  and  mal- 
rotation of  the  colon  was  found  with  trans- 
duodenal  constricting  bands.  Mid-gut  vol- 
vulus was  reported  to  be  present  and  was 
corrected.  The  constricting  bands  were  cut 
and  the  patient  improved  during  the  sub- 
sequent three  weeks.  He  gained  weight 
slowly  and  was  sent  home. 

Two  weeks  later,  he  was  brought  back 
to  the  same  hospital  with  a temperature  of 
101°,  marked  abdominal  distention,  vomit- 
ing and  bloody  diarrhea.  Roentgenograms 


,'.90 


Illinois  Medical  Journal 


Fig.  2.  Radiologic  study  of  the  colon  does  not  demonstrate  obstruction  but  the  cecum  is  abnorm- 
ally high. 


were  reported  to  demonstrate  partial  ob- 
struction at  the  duodenal-jejunal  junction 
with  a leak  into  the  peritoneal  cavity.  He 
was  operated  upon,  and  almost  complete 
necrosis  of  the  mid-gut  was  found.  At  that 
time,  more  than  40  cm.  of  jejunum  and 
ileum  were  resected.  There  was  diffuse  in- 
traperitoneal  sepsis  with  several  abscesses. 
After  a period  of  five  days,  when  feeding 
of  glucose  water  was  instituted,  bile-stained 
drainage  appeared  in  the  mid-portion  of 
his  abdominal  wound.  Radiologic  study 
showed  a fistula  arising  from  the  level  of 
the  duodenal-ileal  anastomosis.  He  was 
transferred  to  Children’s  Memorial  Hospi- 
tal for  further  therapy. 

When  admitted,  he  was  well  hydrated; 
serum  electrolytes  were  within  normal  lim- 
its. An  external  jugular-superior  vena  cava 
hyperalimentation  feeding  catheter  was  in- 
serted and  feedings  begun.  He  started  to 
gain  weight  at  the  rate  of  10  to  60  grams 
per  day  and  the  fistula  closed  after  two  days. 
However,  he  began  to  vomit  bile  stained 
material,  which  suggested  obstruction  at  the 
level  of  the  fistula  and  anastomosis.  After 
X-ray  study,  an  operation  was  again  per- 
formed. At  this  time,  a dilated  duodenum 
was  found  proximal  to  the  previous  anas- 
tomosis. About  1 cm.  distal  to  the  duodeno- 


ileal  anastomosis,  there  was  complete  ne- 
crosis of  the  small  bowel  extending  to  the 
cecum.  An  anastomosis  of  the  duodenum 
to  the  cecum  was  performed.  At  the  present 
time,  the  child  continues  to  improve.  He  is 
vigorous,  healthy,  and  gaining  weight  again, 
although  he  only  has  approximately  10  cm. 
of  small  bowel. 

Dr.  Al)ram  H.  Cannon : These  are  the 
plain  film  studies  of  the  abdomen  that  were 
made  initially,  showing  mrdtiple  distended 
loops  of  small  bowel,  brought  out  best  on 
the  erect  film.  (Fig.  1)  The  multiple  fluid 
levels  within  the  small  bowel  indicate  a 
small  bowel  obstruction.  A colon  study 
done  at  this  time  reveals  no  obstruction  of 
the  colon.  The  cecum  occupies  a very  high 
position,  suggesting  some  malrotation  is 
present.  (Fig.  2)  The  stomach  study  was 
done  about  the  same  time  as  the  colon  study 
and  shows  that  the  stomach,  duodenum  and 
small  bowel  are  normal.  (Fig.  3) 

After  an  operation,  the  child  returned 
with  clinical  symptoms  of  a small  bowel  ob- 
struction. A film  of  the  abdomen  at  this 
time  has  non-specific  findings.  There  are 
some  dilated  loops  of  small  bowel  which, 
with  the  clinical  findings,  suggest  a small 
bowel  obstruction. 

This  gastrographin  study  shows  the 


for  December,  1970 


591 


Fig.  3,  X-rays  of  the  upper  gastrointestinal  tract 
are  not  remarkable. 

Stomach  filled  with  the  gastrographin. 
There  is  a fisttda  in  the  region  of  the  anas- 
tomosis (Fig.  4)  that  was  previotisly  per- 
formed, with  the  fistula  apparently  right 
at  the  anastomotic  site. 

Dr.  Julius  Conn,  Jr.:  Is  that  first  and  sec- 
ond film  the  usual  picture  of  a volvulus 
with  a closed  loop  obstruction? 

Dr.  Cannon:  I couldn’t  diagnose  that  from 
these  films.  All  I can  say  is  that  there  is  a 
small  bowel  obstruction.  Usually,  with  a 
closed  loop  obstruction,  a greatly  dilated 
loop  of  bowel  will  be  seen. 

Dr.  Joseph  O.  Sherman:  Perhaps  the  best 
way  to  discuss  this  case  is  to  initially  talk 
about  malrotation  and  then  about  this  child 
in  partictdar. 

During  embryonic  development  there  is 
a concomitant  counter-clockwise  rotation  of 
the  duodenal-jejunal  loop  and  the  cectim 
around  the  superior  mesenteric  artery. 

In  the  5 mm.  embryo,  the  stomach,  duo- 
denum, small  bowel  and  colon  are  all  ven- 
tral to  the  superior  mesenteric  artery.  Ro- 
tation of  the  duodenal-jejunal  loop  places 
the  duodenal-jejunal  junction  in  its  normal 
position  in  the  left  upper  quadrant  in  the 
-10  mm.  ejnbryo.  This  rotation  can  stop  at 
any  point  between  the  original  ventral  posi- 
tion and  the  left  upper  quadrant.  Thus, 
the  duodenal-jejunal  loop  can  be  located 
entirely  on  the  right  side  or  any  place  be- 
tween the  RUQ  and  the  LUQ.  The  im- 
portance of  this  is  that  with  the  duodenal- 
jejunal  loop  located  entirely  to  the  right  of 
the  superior  mesenteric  artery,  we  have 
growth  and  elongation  of  the  proximal 


small  bowel  with  kinking  which  can  pro- 
duce obstruction.  Secondly,  the  rotation  of 
the  duodenal-jejunal  loop  brings  the  proxi- 
mal mesentery  to  the  LUQ  so  that  it  has 
a broad  attachment  from  the  LUQ  down 
across  the  retroperitoneal  area  to  the  RLQ. 
This  broad  attachment  minimizes  the 
chance  of  midgut  volvulus.  Among  patients 
with  malrotation,  the  mesentery  is  attached 
retroperitoneally  by  a narrow  stalk  at  the 
point  of  origin  of  the  superior  mesenteric 
artery. 

At  the  same  time  the  duodenal-jejunal 
loop  is  attaining  its  normal  location,  the 
cecum  is  also  rotating  around  the  superior 
mesenteric  artery.  Here  again  the  cecum  is 
rotating  cotinter-clockwise  around  the  su- 
perior mesentery  to  reach  its  normal  loca- 
tion in  the  RLQ.  In  most  cases  of  malrota- 
tion the  cecum  is  usually  located  in  the 
LUQ  or  the  RUQ.  Failure  of  complete  ro- 
tation of  the  cecum  to  the  RLQ  results  in 
the  formation  of  fibrous  adhesions,  Ladd’s 
bands,  fiom  the  cecum  across  the  duode- 
num to  the  RUQ.  These  bands  can  produce 
partial  or  complete  duodenal  obstruction. 


Fig.  4.  Gastrographin  study  demonstrates  a fis- 
tula in  the  region  of  the  anastomosis. 

So  we  have  some  kinking  of  the  duodenal- 
jejunal  loop  because  of  elongation  and  fail- 
ure of  rotation,  inadequate  attachment  of 
the  mesentery  and  a beautiful  set-up  for 
midgut  volvidus  and  Ladd’s  bands  from  the 


592 


Illinois  Medical  Journal 


cecum  to  the  RUQ.  In  addition,  10%  of 
these  patients  have  an  intrinsic  obstruction 
of  the  duodenum. 

d'hese  children  usually  present  during  the 
first  five  days  of  life  with  a high  bowel  ob- 
struction. Occasionally  they  present  in  later 
life  with  minimal  obstruction.  If  there  is 
a high  degree  of  duodenal  obstruction,  we 
see  the  typical  double  bubble  picture  of 
duodenal  obstruction  in  supine  and  up- 
right X-rays  of  the  abdomen. 

Normally,  these  children  have  bile-stained 
vomiting  and  minimal  abdominal  disten- 
tion. The  presence  of  bloody  stools  is  a very 
poor  prognostic  sign  because  it  suggests  a 
concomitant  mid-gut  volvulus. 

Immediately  after  admission,  this  patient 
was  started  on  parenteral  hyperalimenta- 
tion. We  infuse  a mixture  of  3%  Amino- 
sol  and  20%  glucose  with  added  electro- 
lytes and  vitamins.  We  place  the  infusion 
catheter  in  the  superior  vena  cava  and 
maintain  a constant  flow  by  using  an  IVAC 
400  peristaltic  pump.  In  addition,  a Milli- 
pore  filter  is  placed  in  the  IV  tubing  to  re- 
duce the  chances  of  infusing  any  bacteria, 
yeast  or  particulate  matter  which  might  be 
present  in  the  bottle  of  hyperalimentation 
solution. 

Initially  the  child  was  draining  40  to  50 
ml.  per  day  of  bile  from  the  wound.  This 
fistula  closed  two  or  three  days  after  start- 
ing hyperalimentation.  Preoperatively  the 
patient  received  parenteral  hyperalimenta- 
tion for  one  month  and  gained  one  pound 
and  fohr  ounces. 

We  approached  him  this  time  through  a 
transverse  left  upper  abdominal  incision. 
We  found  complete  atresia  of  the  small 
bowel  beginning  1-2  cm.  distal  to  the  ana- 
stomosis. The  only  thing  I could  do  at  sur- 
gery was  to  anastomose  the  duodenum  or 
little  bit  of  jejunum  to  the  cecum.  There 
was  no  ileocecal  valve  or  ileum  present. 

Normally,  we  treat  a malrotation  by  re- 
ducing the  mid-gut  volvulus,  usually  with 
a counter-clockwise  rotation  of  the  bowel. 
Next,  we  cut  the  bands  across  the  duode- 
num. We  attempt  an  appendectomy  if  the 
child  is  in  good  shape  because  with  the 
cecum  located  in  the  right  upper  or  left 
upper  quadrant,  it  might  be  difficult  to 
make  a diagnosis  of  appendicitis  in  later 
life.  We  very  carefully  pass  a catheter 
through  the  entire  duodenum  and  jejunum 
to  make  sure  there  is  no  intrinsic  obstruc- 
tion, and  we  also  straighten  out  the  duo- 


denum and  make  sure  there  are  no  kinks, 
which  are  also  common  and  can  produce 
obstruction. 

Right  now,  we  have  a bit  of  a problem 
with  this  infant.  The  child  is  going  to  gain 
as  long  as  he  is  on  hyperalimentation.  We 
had  one  child  with  25  cm.  of  bowel  which 
survived  and  is  doing  well.  I think  the 
lecord  for  survival  in  a patient  with  the 
short  bowel  syndrome  is  around  15  or  20 
cm.  I don’t  think  anyone  has  ever  lived  with 
less  than  that  amount  of  small  bowel. 

Dr.  William  Donnellan:  This  case  empha- 
sizes the  need  for  intestinal  transplantation. 
What  progress  has  been  made  in  this  field? 
Dr.  Stuart  Poticlia:  Hyperalimentation 
can  also  be  used  to  prepare  a patient  for 
an  intestinal  transplant.  The  first  intestinal 
transplant  was  performed  in  1967  by  Dr. 
Richard  Lillehei.  The  patient  was  a 47- 
year-old  woman  who  suffered  a mesenteric 
venous  thrombosis  with  an  infarction  of  her 
entire  small  bowel.  This  was  resected  and 
the  patient  was  placed  on  hyperalimenta- 
tion for  a few  weeks,  at  which  time  she  re- 
ceived an  intestinal  transplant  consisting 
of  the  entire  small  bowel  and  right  colon. 
Unfortunately,  the  patient  died  12  hours 
after  the  operation  from  a pulmonary  em- 
bolus. Since  then,  there  have  been  at  least 
two  other  unsuccessful  attempts  to  trans- 
plant the  intestine  in  humans.  With  such 
rapid  advancements  in  the  field  of  trans- 
plantation, successful  intestinal  transplants 
may  very  well  be  possible  in  the  near  fu- 
ture. Hyperalimentation  can  provide  us 
with  a means  of  supporting  an  intestinal 
cripple  until  his  intestinal  tract  can  be 
restored. 

Dr.  Conn:  What’s  the  significance  of  the 
Millipore  filter? 

Dr.  Sherman:  The  mean  diameter  of  the 
pores  is  0.22  microns  and  no  bacterium  can 
pass  through  them.  The  solution  we  use  is 
an  excellent  culture  media,  especially  for 
Candida  albicans.  Since  we  have  to  mix  the 
solution  ourselves,  we  are  worried  about 
contamination  and  we  do  know  that  we 
can  minimize  the  chances  of  passing  con- 
taminants from  the  solution  into  the  baby 
with  this  filter. 

Dr.  Conn:  Do  you  use  heparin  in  your 
solution? 

Dr.  Sherman:  We  do  not  use  heparin,  al- 
though this  had  been  advocated  by  some 
investigators. 

(Continued  on  page  617) 


for  December,  1970 


593 


The  first  hemodialysis  program  for  treatment  of  patients  with 
end-stage  renal  failure  was  established  in  Seattle  ten  years  ago. 
There  followed  a period  of  vigorous  expansion,  and  gradually, 
an  increasing  number  of  patients  was  treated  with  the  artificial 
kidney.  Today  over  3,500  patients  are  maintained  by  chronic 
dialysis  programs  located  throughout  the  country;  of  these,  ap- 
proximately 250  are  treated  in  Illinois. 

Hemodialysis  represents  both  a miracle  and  compromise.  A 
miracle  because  it  has  given  life  where  death  would  otherwise 
have  been  inevitable;  a compromise  because  it  remains  an  imper- 
fect mode  of  therapy.  Its  very  existence  emphasizes  our  impotence 
in  the  face  of  diseases  which  we  can  neither  prevent  nor  cure.  Yet 
as  we  enter  a new  decade,  hemodialysis  and  renal  transplantation 
remain  the  only  hope  for  most  patients  afflicted  with  renal  failure. 


Hemodialysis 

1970 


By  George  Dunea,  M.B.,  M.R.C. P./Chicago 


Medical  Progress 


Harvey  Kravitz,  M.D. 
Medical  Progiess  Editor 


Equipment 

The  principle  of  the  artificial  kidney  is 
simple  and  many  different  types  have  been 
proposed  in  the  last  quarter  of  a century. 
Yet  few  are  commercially  available,  and 
the  choice  is  limited  to  a handful  of  plate 
or  coil  dialyzers. 

Plate  dialyzers  are  popular  with  many 
centers  because  they  are  safe,  inexpensive, 
require  little  blood  for  priming  and  allow 
for  a smooth  dialysis.  Coil  dialyzers  offer 
the  advantage  of  convenience,  ease  of  as- 
sembly and  high  efficiency.  With  the  de- 
velopment of  better  coil  dialyzers,  wastage 
of  blood  has  ceased  to  be  a problem.  A 
blood  pump  is  now  usually  required  for 
all  types  of  dialyzers  because  of  the  in- 
creased use  of  the  internal  subcutaneous 
fistula. 

Two  main  types  of  coil  dialyzers  are 


594 


Illinois  Medical  Journal 


used  at  the  present  time:  the  Ultra-Flo* 
models,  which  are  improved  versions  of  the 
original  Twin-Coil;*  and  the  EX-Dialyzer 
Cartridges,**  which  employ  a single,  rather 
than  a double  blood  channel.  The  recently 
developed  EX-03  Dialyzer  Cartridge^**  is 
easy  to  use,  effective  and  removes  more 
water  than  the  earlier  EX-01.-**  Its  char- 
acteristics are  summarized  in  Table  I.  At 
the  end  of  dialysis  the  blood  is  easily  re- 
turned to  the  patient.  If  desired,  the  coil 
can  be  reused  several  times  by  storing  it  in 
a refrigerator  or  in  saturated  salt  solution. 
A procedure  for  reusing  coils  has  recently 
been  described  in  detail.^ 

Table  I — The  EX-03  Dialyzer  cartridge 

Volume  200-280  ml. 

Membrane  18  micron  thick  cuprophan 

Dialyzing  area  0.84  m^ 

Urea  dialysance  134  ml/min  (flow  rate  of  200) 
166  ml/min  (flow  rate  of  300) 
% Urea  reduction  (6  hrs.) — abt.  70% 

% Creatinine  reduction  (6  hrs.) — aht.  60% 
Average  ultrafiltration  (6  hrs.) — 2.5Kg 
Maximal  ultrafiltration  (6  hrs.) — 5 Kg 

A variety  of  dialysis  systems  are  in  use 
throughout  the  country.  Multiple  delivery 
systems  have  been  installed  in  some  large 
centers  and  are  convenient  for  dialysis  of 
large  numbers  of  patients.  Single  units  have 
the  advantage  of  flexibility  and  are  more 
suitable  for  smaller  units  and  for  training 
patients  for  home  dialysis.  These  systems 
vary  in  size,  construction,  number  of  safety 
devices  and  cost.  Disposable  coils  may  be 
used  in  an  inexpensive  domestic  washing- 
machine^’^  or  in  a standard  Travenol 
Tank.*  The  more  elaborate  Recirculating- 
Single-Pass  (RSP)*  machine  is  more  con- 
venient but  also  more  expensive.  Unfor- 
tunately it  cannot  be  adapted  for  simul- 
taneous use  for  two  patients. 

Although  the  last  decade  has  brought  no 
major  breakthrough  in  technology,  num- 
erous advances  have  contributed  to  make 
dialysis  safer,  simpler  and  more  convenient. 
New  membrane  materials  such  as  cupro- 
phan and  better  membrane  supports  have 
allowed  the  construction  of  effective  dia- 
lyzers  with  low  priming  volumes.  A va- 
riety of  safetv  devices  such  as  blood  leak 
detectors  and  positive-negative  pressure 
gauges  have  become  available.  The  develop- 

*TravenoI  Laboratories,  Morton  Grove,  Illinois 
** Extracorporeal  Medical  Specialties,  Mt.  Laurel 
Township,  New  Jersey 


ment  of  commercially  manufactured  dia- 
lysate  concentrates  has  minimized  the  pos- 
sibility of  error  in  preparing  the  dialysis 
bath.  The  new  all-silastic  arteriovenous 
shunts  are  an  improvement  over  earlier 
models  because  they  have  neither  metal 
crimp  rings  nor  multiple  connecting  pieces. 
New  roller  blood  pumps  have  become 
available,  replacing  the  older,  noisy,  finger 
pumps. 

Increasing  clinical  experience  has  done 
away  with  the  need  for  numerous  labora- 
tory tests.  Schedules  for  heparin  administra- 
tion have  been  simplihed.  The  need  for 
more  frequent  dialysis  and  proper  nutri- 
tion has  become  increasingly  recognized. 
The  reduction  in  blood  transfusion  re- 
quirements has  lowered  costs  and  decreased 
the  risk  of  hepatitis.  Some  patients  have 
never  received  a blood  transfusion  and  yet 
have  hematocrit  levels  of  20-24%;  others 
feel  well  and  are  able  to  work  with  hema- 
tocrits of  14-16%. 

Acute  Dialysis 

The  interest  in  chronic  renal  failure  has 
overshadowed  the  problems.  Moreover,  the 
prophylatic  use  of  mannitol  and  adequate 
hydration  of  the  surgical  patient  has  led  to 
a genuine  reduction  in  the  incidence  of 
acute  renal  failure.  Yet  “acute  tubular  ne- 
crosis” remains  a serious  problem  and  the 
mortality  is  still  too  high. 

Some  patients  may  be  treated  adequately 
by  conservative  methods  but  others  require 
dialysis.  Most  can  be  treated  equally  well 
by  peritoneal  or  hemodialysis  and  the 
choice  may  depend  on  available  facilities, 
technical  factors  or  the  preference  of  the 
physician.  However,  hemodialysis  is  gen- 
erally needed  in  the  severely  ill,  hypercata- 
bolic  patient  who  may  have  had  infection, 
trauma,  surgery  or  intra-abdominal  prob- 
lems. Here  the  mortality  rate  is  70-90%, 
death  being  usually  the  result  of  the  under- 
lying condition.  Only  by  early  referral  and 
vigorous,  preferably  daily,  hemodialysis,  can 
there  be  any  hope  of  reducing  this  high 
mortality  rate. 

Acute  hemodialysis  is  a difficult  proced- 
ure and  is  best  done  by  an  experienced 
team.  Some  patients  are  extremely  ill  and 
only  meticulous  attention  to  detail  will 
avoid  accidents.  A physician  should  be  in 
attendance  and  constant  monitoring  is  a 
wise  precaution.  Blood  should  be  available 


for  December,  1970 


595 


and  a respirator  may  be  needed.  The  pos- 
sibility of  digitalis  intoxication  should  be 
borne  in  mind  and  the  potassium  concen- 
tration in  the  dialysis  bath  may  need  ad- 
justment. There  is  a risk  of  vomitus  aspi- 
ration and  a suction  apparatus  should  al- 
ways be  on  hand.  The  stomach  may  have  to 
be  emptied  by  tube  and  tracheal  intuba- 
tion, or  tracheostomy  may  be  necessary. 
Fluid  balance  may  be  complicated  by  ex- 
cessive gastrointestinal  losses.  Regional  hep- 
arinisation  may  be  indicated  if  there  is  a 
bleeding  tendency.  Yet,  even  with  all  these 
precautions,  the  mortality  of  the  severely 
ill  patients  with  acute  renal  failure  remains 
too  high. 

Maintenance  dialysis 

Currently  of  the  3,500  patients  now  be- 
ing treated  in  the  United  States  by  main- 
tenance dialysis,  many  are  dialyzed  in  hos- 
pitals, but  an  increasing  number  have  been 
moved  into  the  home  or  into  satellite  units. 
It  has  been  estimated  that  approximately 
25  new  patients  per  million  of  population 
will  require  treatment  every  year.®  Only 
the  increased  use  of  home  dialysis  or  renal 
transplantation  will  avoid  the  eventual  sa- 
turation of  hospital  facilities.  Yet  renal 
transplantation  remains  restricted,  by  the 
limited  supply  of  cadaver  kidney  donors 
and  home  dialysis  is  not  always  feasible. 
Even  more  difficult  is  the  problem  of  the 
indigent,  often  severely  hypertensive  pa- 
tient who  may  be  unsuitable  for  both  trans- 
plantation and  home  dialysis. 

Many  chronic  dialysis  patients  have  been 
rehabilitated  and  have  returned  to  work. 
Yet  their  life  always  remains  uncertain  and 
the  mortality  rate  exceeds  10%  per  year.® 
An  increasing  number  of  complications 
have  been  described,  some  technical,  others 
medical.  They  may  affect  every  system  of 
the  body.  (Table  II) 

With  increasing  experience,  the  incidence 
and  severity  of  many  complications  has 
been  reduced.  The  risk  of  hepatitis  has 
been  lessened  by  decreased  blood  transfu- 


George  Dunea,  M.B.,  M.R.- 
C.F*.,  is  chairman  of  Renal 
D isease  at  Cook  County  Hos- 
pital, and  associate  professor 
of  medicine  at  the  University 
of  Health  Sciences,  Chicago 
Medical  School.  He  received 
his  M.B.  from  the  University 
of  Sydney,  Australia  and  his 
M.R.C.P.  in  London  and 
Edinburgh. 


sion  requirements.  Weakness,  malaise  and 
general  ill-health  can  be  avoided  by  ade- 
quate dialysis  and  good  nutrition.  Early 
use  of  dialysis  in  chronic  renal  failure  may 
prevent  the  development  of  severe  clinical 
peripheral  neuropathy. 

Table  II — Complications  with 
hemodialyses 

1.  Technical:  Membrane  rupture,  clotting  in  the 

coil,  leakage  from  connections,  air  em- 
bolism, wrongly  prepared  dialysate;  cop- 
per, calcium  or  magnesium  intoxication; 
acidosis,  hyjterglycemia,  relative  hypogly- 
cemia, hypotension,  bleeding  from  heparin 

2.  Av  shunt:  Clotting,  bleeding,  infection,  ex- 

trusion 

3.  Vascular:  Hypertension,  hypotension 

4.  Cardiac:  Heart  failure,  pericarditis,  arryth- 

mias,  endocarditis,  ? myocardiopathy 

5.  Neurological:  Dysequilibrium,  strokes,  con- 

vulsions, neuropathy,  subdural  hematoma 

6.  Pulmonary:  Septic  emboli,  uremic  pleuritis. 

effusions,  pulmonary  edema 

7.  Blood:  Anemia,  neutropenia,  thrombocytope- 

nia, bleeding,  anticoagulation  rebound, 
hemosiderosis 

8.  Gastrointestinal:  Hepatitis,  hematemesis 

9.  Psychological:  Anxiety,  depression,  psychosis, 

suicide 

10.  Skin:  Pi-uritus,  pigmentation 

11.  Locomotor:  Osteodystrophy,  arthritis 

12.  Endocrine:  Sterility,  amenorrhea,  gynecomas- 

tia 

Tlie  most  troidjlesome  complications  are 
related  to  the  arteriovenous  shunt,  hyper- 
tension and  renal  bone  disease.  Clotting 
and  infection  of  the  arteriovenous  shunt 
are  frequent  and  extrusion  or  bleeding  may 
also  occur.  This  has  led  to  the  increased 
use  of  the  Brescia-Cimino  internal  arterio- 
venous fistula  which  despite  its  obvious 
disadvantages,  offers  a less  complicated 
course  than  the  external  shunt.® 

Hypertension  and  its  effects  on  the  heart 
and  brain  probably  constitutes  the  com- 
monest cause  of  death  in  patients  main- 
tained by  chronic  dialysis.  The  need  for 
adequate  control  of  hypertension  cannot 
be  overemphasized,  and  bilateral  nephrec- 
tomy should  be  considered  if  fluid  restric- 
tion and  antihypertensive  therapy  prove 
ineffectual.  Renal  osteodystrophy  remains 
a distressing  complication  of  maintenance 
dialysis.  Symptoms  usually  appear  in  the 
second  or  third  year  of  dialysis  and  may 
include  fractures  of  the  ribs  or  femur.  The 
pathogenesis  is  poorly  understood  and  the 
means  of  prevention  are  by  no  means 
agreed  upon.  Promising  results  have  been 
reported  with  the  use  of  dihydrotachy- 
sterol.'^' 


596 


Illinois  Medical  Journal 


Dialysis  in  Illinois 

The  high  cost  of  dialysis  remains  a ma- 
jor obstacle  to  its  wider  use.  Many  patients 
with  chronic  renal  failure  have  been  de- 
nied treatment  for  the  simple  reason  that 
they  could  not  pay  for  it.  Only  by  a co- 
operative effort  between  public  and  private 
agencies  can  hemodialysis  be  brought  to 
those  who  need  it.  In  this  respect  the  State 
of  Illinois,  by  its  enlightened  attitudes  and 
legislation,  has  been  a pioneer  in  the  field. 

In  1967,  the  Illinois  General  Assembly 
passed  a bill  which  provided  for  an  appro- 
priation of  one  million  dollars  for  the  bi- 
ennium to  the  Department  of  Public 
Health  for  direct  care  of  patients  suffering 
from  terminal  renal  failure.  The  Bill  also 
called  for  the  appointment  of  an  11-man 
Advisory  Committee  to  assist  in  the  estab- 
lishment of  such  a program.  The  admin- 
istration of  the  program  w’as  assigned  to 
the  Bureau  of  Chronic  Illness  of  the  Divi- 
sion of  Health  Care  Facilities  and  Chronic 
Illness.  Medical  criteria  for  patient  selec- 
tion and  standards  for  institutional  parti- 
cipation were  developed  by  a medical  sub- 
committee of  the  Advisory  Committee. 
Financial  eligibility  requirements  for  ac- 
ceptance and  for  patient  sharing  in  the 
cost  of  medical  care  were  established  by  an- 
other subcommittee.  A system  of  coopera- 
tion between  the  Departments  of  Public 
Health,  Public  Aid  and  Vocational  Reha- 
bilitation was  worked  out.  Under  this  sys- 
tem medical  referrals  for  dialysis  are  routed 
through  the  Department  of  Public  Health 
for  approval.  The  Department  of  Public 
Aid  pays  for  dialysis  for  patients  eligible 
for  public  assistance.  The  Division  of  Vo- 
cational Rehabilitation  supplies  aitificial 
kidney  machines  on  a limited  basis.  A cost 
of  |200  per  dialysis  was  initially  agreed 
upon.  Later  this  was  reduced  to  $180  for 
institutional  dialysis,  $90  for  home  dialysis 
and  $220  per  dialysis  for  home  training. 

Criteria  for  eligibility  have  been  modi- 
fied from  time  to  time.  In  general,  selec- 
tion of  patients  has  been  limited  to  candi- 
dates between  the  ages  of  18-60  years  who 
were  clinically  free  from  other  life-threaten- 
ing disease,  showed  an  adequate  degree  of 
understanding,  motivation  and  emotional 
stability,  and  were  considered  potentially 
capable  of  rehabilitation.  It  was  felt  that 
patients  should  not  have  disabling  clinical 
problems  such  as  listed  in  Table  III.  How- 
ever, candidates  were  considered  on  their 


own  merits  and  many  exceptions  were 
made. 

The  first  patient  was  accepted  to  the 
program  on  March  15,  1968.  As  of  August 
1970,  there  were  197  patients  being  treated 
in  approximately  20  centers  or  units,  some 
outside  Illinois.  (To  this  must  be  added 
approximately  65  patients  treated  in  Vet- 
erans’ Hospitals  in  Illinois.) 

Table  III — Contraindications  to 
maintenance  dialysis  (relative) 

1.  Coronary  artery  disease 

2.  Liver  disease 

3.  Chronic  progressive  neurological  disease 

4.  Chronic  pulmonary  disease 

5.  Irreversible  heart  disease 

6.  Malignant  disease  within  five  years 

7.  Severe  organic  gastrointestinal  disease 

8.  Essential  (primary)  malignant  hypertension 

with  severe  and  organ  involvement 

9.  Diabetes  mellitus  with  generalized  angio- 

neuropathy 

10.  Systemic  lupus  erythematosus 

11.  Scleroderma 

12.  Amyloidosis 

13.  Polyarteritis  Nodosa 

14.  Rapidly  progressive,  disabling  uremic  neu- 

ropathy 

15.  Severe  psychiatric  disorders 

This  program  has  played  a major  role 
in  the  development  of  chronic  dialysis  fa- 
cilities in  the  state.  Many  states  have  pat- 
terned legislation  after  that  adopted  in 
Illinois. 

Conclusion 

A small  but  increasing  number  of  pa- 
tients with  end-stage  renal  failure  has  been 
given  a new  lease  on  life  by  the  artificial 
kidney.  At  present,  facilities  remain  restrict- 
ed, the  cost  high  and  the  clinical  results 
variable.  Yet  the  success  of  such  a program 
must  not  be  measured  only  in  terms  of  im- 
mediate results.  The  increasing  use  of  dia- 
lysis has  added  to  our  understanding  of 
renal  disease  and  stimulated  research  into 
medical  and  technological  problems.  It  has 
resulted  in  enlightened  cooperative  ap- 
proaches by  government  departments  and 
private  agencies.  The  expanding  market 
has  provided  the  incentive  for  industry  to 
innovate,  support  research  and  manufac- 
ture new  products. 

It  is  not  too  much  to  hope  that  the  fu- 
ture will  bring  new  methods  to  prevent  and 
cure  renal  disease  or  at  least,  a better  under- 
standing of  the  pathogenesis  of  the  uremic 
state.  One  may  also  be  sure  that  technologi- 
(Continued  on  page  632) 


for  December,  1970 


597 


This  is,  of  course,  a day  which  belongs 
to  the  graduates.  It  marks  a turning  point 
in  their  career  of  learning  and  service.  In 
medicine,  one  faces  a lifetime  of  learning 
and  a lifetime  of  service.  A great  deal  is  ex- 
pected of  medicine  these  days  and  physi- 
cians are  very  much  in  demand. 

It  is  generally  recognized  now  that  medi- 
cal care  should  be  available  to  all  people, 
regardless  of  their  ability  to  pay,  bringing 
the  best  quality  of  care  to  them  when  they 
need  it.  However,  it  is  also  recognized  by 
all  that  our  health  services  are  in  a state 
of  crisis.  There  probably  has  never  been 
a time  in  our  history  when  so  many  peo- 
jDle  have  been  looking  so  questioningly  at 
our  health  services  system.  The  discontent 
stems  from  the  human  relations  aspect  of 
the  medical  care  services  which  many  in- 
dividuals receive,  from  the  unavailability 
of  adequate  care  for  certain  sections  of  our 
population,  the  short  supply  of  personnel 
and  certain  types  of  facilities,  and  from 
the  problems  of  financing  comprehensive 
care  for  our  population. 


The  medica 

th^ 

and  medica) 

i 

I 

By  Cecil  G.  Sheps,  M.D.,  M.P.H. 


Commeuceynent  address  at  the  Chicago  Medical  School/ 

Ujiiversity  of  Health  Sciences,  June  13,  1970. 

, 


We  recognize  now,  more  than  ever  be- 
fore, that  medical  science  is  inseparable 
from  the  community  and  society,  and  that 
our  task  is  to  address  ourselves  more  direct- 
ly to  the  problems  of  the  application  of 
science  to  the  needs  of  man  and  the  needs 
of  society.  This  means  that  medicine  and 
science  must  face  a deeper  involvement 
with  society  and  social  problems. 

The  depth  of  concern  and  commitment 
of  today’s  students  is  probably  unparalleled 
in  the  history  of  our  country.  I,  for  one, 
welcome  this  enthusiastically.  It  is  our  last 
best  hope! 

It  is  understandable  that  the  uneven  ap- 
preciation of  the  depth  and  nature  of  our 
problems  as  a society,  not  to  mention  the 
slow  and  halting  progress  towards  their 
solution,  should  produce  frustration  and 
unrest.  As  Dr.  Leon  Eisenberg,  professor 
of  psychiatry  at  Harvard  Medical  School 
recently  has  said,^  “To  label  unrest  as 
‘sick’  is  no  more  than  a sophisticated  ver- 
sion of  the  rage  of  adults  at  the  effrontery 
of  the  child  who  pointed  out  that  the  Em- 


peror had  no  clothes  on.  In  part,  adult  fury  ^ 

stems  from  the  very  accuracy  of  the  charge 
the  young  lodge  against  us.  This  is  not  to 
say  that  the  correctness  of  the  accusation 
warrants  abject  surrender  by  our  genera- 
tion; the  young  have  no  greater  wisdom  1 

than  we  possess,  and  a good  deal  less  | 

practicality.’’  s 

The  deep  emotion  of  our  youth  today  || 

over  our  problems  is  a crucial  and  essen-  I 

tial  ingredient  for  dealing  with  these  prob-  | 

lems  successfully.  These  strong  feelings  re-  | 

fleet  a commitment  to  a new  value  system  : 

which  puts  human  values  above  all  else. 

Facts  are  given  relevance  by  the  depth  and  i 

consistency  of  attention  we  give  to  them.  j 

The  most  useless  knowledge  is  the  knowl-  ' 

edge  that  is  not  put  to  use. 

It  is  our  value  system,  as  it  actually  oper- 
ates, which  is  now  being  so  seriously  ques-  j 

tioned— and  so  it  should  be.  As  Professor 
Eisenberg  says,  “The  energy,  idealism,  and 
intelligence  of  youth  are  the  prime  re-  :■ 

sources  of  each  nation  . . . youth  is  impa-  J 

tient— as  it  should  be— with  excuses  for  per- 


598 


Illinois  Medical  Journal 


tudent 

3ublic 

3are 


petuating  evil.”  Sincere  feeling,  deep  con- 
cern, and  strong  commitment  are  essential 
conditions  for  a successful  attack  on  the 
problems  that  face  us.  They  are,  however, 
not  enough.  They  provide  a fundamental 
basis  for  action  and  progress.  Professional 
and  technical  knowledge  must  be  harnessed 
to  the  value-judgment  which  impells  us  to 
solve  the  problems  of  our  society.  This 
applies  whether  we  are  talking  of  poverty, 
racial  discrimination,  education  or  health. 

The  urgent  agenda  of  severe  problems 
that  faces  our  nation  is  complex  and  agon- 
izing. Demanding  attention,  it  includes  the 
rapid  termination  of  the  war  in  which  we 
are  now  engaged,  the  development  of  a 
stable  peace,  dealing  effectively  with  the 
problems  of  race,  improving  and  protecting 
our  biological  and  physical  environment, 
providing  adequate  housing,  and  improv- 
ing the  accessibility  and  quality  of  educa- 
tional opportunity  and  health  services  for 
all  people.  At  the  root  of  all  of  this 
is  the  extent  of  our  dedication  to  human 
values,  not  simply  in  our  rhetoric,  but  in 
our  actions  as  a nation.  In  the  field  of 


Cecil  G.  S h e p s,  M.D., 
is  director  of  the 
Health  Services  Research  Cen- 
ter and  professor  of  social 
medicine  at  the  University  of 
North  Carolina. 


health,  we  must  maintain  our  research  ef- 
fort, increase  the  number  and  quality  of 
health  personnel,  and  improve  the  system 
of  delivery  of  health  services. 

Ten  years  ago,  at  a special  institute  or- 
ganized by  the  Association  of  American 
Medical  Colleges  on  the  interactions  be- 
tween medical  education  and  medical  care, 
I concluded  the  opening  presentation  by 
saying:^ 

“I  believe  that  medical  education  has  a 
contribution  to  make  that  no  other  force 
in  our  society  can  make  as  well  in  its  stead. 
This  is  clearly  and  predominantly  the  chal- 
lenge to  medical  education— to  discover, 
through  research,  new  ways  of  applying 
lohat  we  know  in  order  to  reduce  the  lag 
between  development  of  new  knowledge 
and  application  of  it  for  maximum  social 
purpose.  To  achieve  this  end,  medical  edu- 
cation must  reach  beyond  its  usual  subject 
matter.  We  must  acquire  new  concepts,  cul- 
tivate new  fields,  as  well  as  till  the  old 
and  familiar  ones  in  different  ways.” 

Now,  a decade  later,  I would  strengthen 
this  statement  by  pointing  to  two*  factors 
of  great  importance— one  is  the  role  of 
the  student  and  the  other  is  the  role  of 
the  public,  the  consumer.  The  expressed 
concern  of  medical  students  has  alerted 
their  professors  to  the  fact  that  they  must 
give  attention  to  the  quality  and  scope  of 
the  delivery  of  medical  care.  The  vigor  of 
student  interest  has  been  crucial  in  produc- 
ing the  start  that  has  been  made  in  a few 
medical  schools  to  relate  themselves  directly 
to  improving  the  delivery  of  health  serv- 
ices to  the  people  they  serve  and  ought  to 
be  serving,  and  to  involve  students  in  these 
activities  as  a framework  for  their  educa- 
tion. 

The  classic  referral  medical  center  is 
inadequate  as  the  sole  framework  for  the 
preparation  of  physicians  of  the  future.  If 
our  new  physicians  are  to  be  not  only  sci- 
entific but  also  humane,  socially  respon- 
sible and  maximally  effective,  new  models 
of  primary  and  comprehensive  health 
services  to  the  community  must  be  added 
to  the  opportunities  offered  to  medical  stu- 
dents as  a context  for  their  educational 
preparation.  While  recognizing  that  a start 
is  being  made,  I say  to  students  and  young 
physicians,  let  us  not  be  satisfied  with  small 
mercies.  The  continued  interest  of  medical 
students  and  graduates  calling  for  such 
changes  in  the  system  of  medical  education 
is  a vital  ingredient  in  assuring  that  fur- 


for  December,  1970 


599 


ther  progiess  will  be  made. 

Nine  years  ago,  in  analyzing  the  effect 
of  medical  care  insurance  programs  for  the 
readers  of  the  New  England  Journal  of 
Medicine,  a colleague  and  I concluded  by 
saying:^ 

“There  can  be  little  doubt  that  the  pub- 
lic will  remain  earnest  and  vigorous  in  its 
efforts  to  make  sure  that  medical  care  of 
good  quality  is  readily  available  to  every- 
one. . . . It  remains  for  the  medical  profes- 
sion to  exercise  its  best  wisdom  so  that 
medical  care  can  be  rendered  under  condi- 
tions that  are  most  conducive  to  the  high- 
est standard  of  professional  service.  This 
requires  innovation  and  experiment.  It  also 
bespeaks  the  closest  possible  identification 
of  medicine  with  the  public  in  delineatmg 
needs  and  goals,  and  developing  effective 
and  efficient  programs.” 

Now,  almost  a decade  later,  I would  add 
that  without  unrelenting  demands  from  the 
public,  the  medical  profession  will  not 
make  its  best  contribution.  Why  is  this  so? 
The  answer  is  disarmingly  simple.  It  lies 
in  the  very  success  and  rewarding  character 
of  medical  service  these  days.  A physician 
can  work  hard  all  day  doing  his  best  for 
the  patients  who  have  access  to  him— and 
do  them  a lot  of  good. 

At  the  end  of  the  day,  he  naturally 
believes  that  he  has  spent  his  day  in  the 
most  effective  way.  This  may  not  be,  and 
often  is  not,  the  case.  Too  often  the  pa- 
tients who  do  not  have  access  to  him,  and 
the  health  problems  he  does  not  tackle, 
arc  of  much  greater  importance  to  the 
community.  With  a few  notable  exceptions 
in  certain  organized  programs,  the  physi- 
cian does  not  function  in  a framework 
which  enables  him  to  plan  his  work  so  as 
to  prevent  and  treat  the  most  severe  health 
problems  of  his  community.  As  a solo  pri- 
vate entrepreneur,  he  may  indeed  be  very 
Itusy,  using  his  professional  and  technical 
skills  in  helping  patients  who  come  to  him. 
The  value  of  this  to  the  health  and  welfare 
of  his  community  is,  however,  often  much 
less  than  it  would  be  if  his  work  were 
focused  in  a planned  purposeful  manner 
upon  those  health  problems  in  which  his 
special  knowledge  and  skills  can  best  be 
used  to  enhance,  protect  and  restore  the 
health  of  those  in  the  community  who  are 
most  vulnerable,  most  in  need  and  most 
susceptible  to  these  ministrations.  That’s 
not  the  system  we  have  now.  What  we  have 
has  been  called  a non-system,  the  last  of 
the  cottage  industries. 


The  federal  government  has  recently 
proposed  some  action  which  could,  I be- 
lieve, serve  to  re-orient  the  delivery  of 
health  services.  This  calls  for  the  develop- 
ment of  a new  option  in  Medicare  for 
comprehensive  health  maintenance  services. 
Eligible  individuals  would  have  a choice  of 
a different  type  of  coverage— the  current 
Part  A (for  hospitalization)  and  Part  B 
(for  physician  services)  plus  a new  Part  C 
which  would  guarantee  on  the  part  of  the 
provider  (a  health  maintenance  organiza- 
tion) that  “.  . . all  services  under  Parts  A 
and  B of  Medicare  plus  preventive  services 
will  be  available  . . .”  on  the  basis  of  “.  . . 
payment  of  a hxed  annual  sum  negotiated 
in  advance.  . . .”  It  is  contemplated  that 
the  health  maintenance  organization  would 
bring  together,  in  a planned  program,  the 
health  care  resources  necessary  to  the  pa- 
tient rather  than  the  current  arrangement 
where,  in  the  main,  the  individual  must 
seek  each  kind  of  care  separately.  The  gov- 
ernment believes  that  the  best  interests  of 
the  nation  would  be  served  by  diversity 
and  competition  among  health  maintenance 
organizations  and  other  providers,  fn  addi- 
tion, this  means  that  the  health  services 
delivery  group  undertaking  such  respon- 
sibilities will  be  able  to  plan  for  the  pro- 
tection and  restoration  of  the  health  of 
those  patients  who  are  covered  by  this 
arrangement. 

This  proposal  is  not  an  idealistic  imprac- 
tical dream.  Already,  the  Kaiser  Perman- 
ente  Groups  and  similar  programs  of  pre- 
paid group  practice  are  providing  compre- 
hensive planned  health  services  for  four 
million  people.  Stimulating  such  develop- 
ments in  many  parts  of  the  country,  which 
this  legislation  would  foster,  will  produce 
a healthy  pluralism  in  our  health  services 
delivery  system  and  real  choices  for  the 
American  people. 

Twenty  years  ago,  tax  funds  were  used  to 
pay  for  25%  of  all  expenditures  for  health 
and  medical  care.  By  1966,  it  had  increased 
only  to  26%.  By  1969,  it  had  risen  to  37%. 
Greater  use  of  tax  funds  for  essential  serv- 
ices is  inevitable,  and  in  my  opinion,  neces- 
sary and  wise.  With  it  will  come  greater 
accountability  to  the  public.  The  public 
will  want  to  know  what  is  being  done  to 
provide  health  services  that  meet  the  twin 
objectives  of  effectiveness  and  economy. 
And  it  will  want  to  be  certain  that  the 
needs  of  our  underprivileged  people  in  the 
ghettos  and  rural  areas  are  being  met.  In 


600 


Illinois  Medical  Journal 


the  ghetto  areas  of  the  large  cities  ol  our 
nation,  neighborhood  people,  alienated  by 
the  lack  of  interest  in  the  health  problems 
which  plague  them  most,  frustrated  by  the 
lack  of  services,  have  learned  to  exert  pub- 
lic presstire  in  order  to  force  the  hospitals 
in  their  community  to  modify  their  serv- 
ices appropriately— for  example,  to  pro- 
vide prenatal  care,  to  develop  adecjuate 
emergency  room  services,  to  find  and  treat 
lead  poisoning  and  to  treat  narcotic  addic- 
tion. The  protests  in  our  cities,  the  pickets, 
demonstrations  and  sit-ins  have  highlighted 
this  need  and  heightened  the  apjareciation 
of  those  who  now  control  these  services 
that  effective  accommodations  must  be 
made  to  the  perceptions,  interests  and  needs 
of  the  people. 

A new  kind  of  partnership  is  needed  in 
the  development  and  operation  of  our 
health  services.  This  partnership  would 
bring  the  needs  and  interests  of  consumers 
into  the  decision  making  structure— not  to 
interfere  with  professional  and  technical 
matters,  but  rather  to  help  focus  their  em- 
phasis and  maximize  their  effectiveness  in 
terms  of  community  needs.  The  people 
whose  lives  and  welfare  are  dependent  upon 
local  institutions  and  programs  should  con- 
trol the  policies  of  these  institutions.  This 
creates  a new  situation  for  the  health  pro- 
fessions. We  must  learn  how  to  do  this 
enthusiastically,  confidently  and  well. 

I have  referred  to  some  elements  of  prog- 
less  and  change  that  are  needed  in  our 
health  services  system.  There  are  others, 
such  as  '^-regionalization  and  improved 
methods ‘of  financing,  about  which  a good 
bit  is  already  known.  The  challenge  which 
we  face  is  not  so  much  one  of  discovering 
the  principles  that  need  to  be  implemented, 
but  rather  of  learning  how  to  take  effec- 
tive action  to  implement  the  already  well- 
recognized  principles  of  teamwork,  region- 
alization, and  the  primacy  of  prevention. 
Physicians  have  a fundamental  role  to 
play  in  this  and  they  have,  in  many  ways, 
the  best  opportunity. 

I’ve  mentioned  social  values.  We  need 
to  reach  a higher  moral  ground  if  we  are 
going  to  move  ahead  decisively  in  dealing 
with  the  problems  which  are  dividing  our 
society.  Physicians  have  a special  role  to 
play  in  getting  us  to  this  higher  rnoral 
ground— and  a special  opportunity— because 
of  their  continuous  exposure  to  the  agoniz- 
ing toll  of  illness  and  premature  death,  and 
the  priceless  value  of  health,  --vigor,  and 
happiness. 


In  May,  the  deans  of  fifteen  medical 
schools  sent  a telegram  to  President  Nixon, 
in  which  they  said,  “Medical  students  com- 
mitted to  a lifetime  of  service  in  the  pres- 
ervation of  health  are  particularly  appalled 
by  the  destruction  of  life  in  war.  The  Cam- 
bodian invasion  has  stirred  deep  frustration 
and  unrest  in  our  own  students  which  we 
share.  We  implore  you  to  take  unequivocal 
actions  to  demonstrate  your  determination 
and  to  end  the  war  quickly  without  exten- 
sion of  misery  to  military  and  civilian  popu- 
lations.” This,  I submit,  is  a relevant  ex- 
pression of  the  higher  moral  ground  to 
which  physicians  can  be  expected  to  rally— 
the  concern  for  human  life. 

Hawthorne  has  said,  “The  world  owes 
its  onward  impulses  to  men  who  are  ill 
at  ease.”  I urge  you  to  continue  to  be  un- 
easy and  dissatisfied.  Do  not  allo^v  your 
absorption  with  the  technical  aspects  of 
your  day-to-day  service  to  individual  pa- 
tients obscure  your  view  of  what  remains 
to  be  done.  Do  not  lose  sight  of  our  urgent 
agenda. 

May  I remind  you  of  the  statement  made 
by  Louis  Pasteur  at  the  opening  of  the 
Pasteur  Institute  in  Paris  in  1888,  “Two 
opposing  laws  seem  to  be  now  in  contest. 
The  one,  a law  of  blood  and  death,  open- 
ing out  each  day  new  modes  of  destruction, 
forces  nations  to  be  always  ready  for  battle. 
The  other,  a law  of  peace,  work  and  health, 
whose  only  aim  is  to^deliver  man  frorn  the 
calamities  which  beset  him.  The  one  seeks 
violent  conquest,  the  other  the  relief  of 
mankind.  Which  of  these  two  laws  will  pre- 
vail, God  only  knows.” 

I urge  each  of  you  to  dedicate  yourselves, 
as  individuals  and  as  a profession  to  the  law 
of  peace,  work  and  health  ...  to  help  de- 
liver man  from  the  calamities  which  beset 
him.  I urge  this  because  it  is  said  that  when 
ypung  men  have,  courage,  the  dreams  of 
old  men  come  true. 

References 

~ -n 

1.  Eisenlierg.  Leon.  "Student  LInrest— Sources  and 
Consequences,”  Science,  Vol.  167,  27  Mar.,  1970, 
1688-1692. 

2.  Sheps.  Cecil  G.,  Medical  Educaiion  and 
Medical  Care:  Interactions  and  Prospects.  A 
report  of  the  Eighth  Teaching  Institute,  1960. 
Copyright  1961,  .Association  of  .American  Medi- 
cal Colleges,  Evanston,  Illinois.  The  book 
appeared  as  Part  2 of  the  /.  Med.  Ed.,  Vol.  36. 
No.  12.  December  1961,  p.  3-20. 

3.  Sheps,  Chcil  G.  and  Drosness,  Daniel  L.  “Pre- 
payment for  Medical  Care,”  Neu<  Eng.  J,  Med  . 

, 261:  390-396:  444-448,  490-499,  (Feb. '23,  March 
2.  and  9)  1961. 


for  December,  1970 


601 


This  is  the  second  and  last  article  based  upon  statistics  collected 
by  means  of  a questionnaire  sent  to  the  5,000  medical  students, 
interns  and  residents  presently  training  in  Illinois.  The  purpose 
was  to  discover  what  our  doctors  in  training  are  going  to  do  and 
if  they  plan  to  stay  in  Illinois.  In  the  first  article,  I reported  that 
two-thirds  of  those  in  training  have  come  from  Illinois,  but  only 
30%  plan  to  practice  in  this  state.  Over  one-third  of  those  who 
plan  to  stay  in  Illinois  plan  to  go  outside  of  Cook  County. 

The  first  statistics  quoted  present  the  answers  to  the  question: 


The  plans  of  our  doctors 


Second  article 


in  training 


By  J.  Ernest  Breed,  M.D.,  ISMS  president 


Do  you  plan 

394  Students 

to  specialize  in 

Yes 

No  No  answer 

family  practice? 

(1?6%) 

38  144 

Other  specialties 

330 

(55.5%) 

Do  you  plan 

252  Interns 

to  specialize  in 

Yes 

No  No  answer 

family  practice? 

14 

(5.5%) 

2 55 

Other  specialties 

181 

(72.0%) 

Do  you  plan 

550 

Residents 

to  specialize  in 

Yes 

No  No  answer 

family  practice? 

8 

(1.0%) 

174  4 

Other  specialties 

364 

(66.0%) 

It  is  most  discouraging  to  learn  that— in 
spite  of  all  our  efforts  in  the  past  few  years 
—only  13.6%  of  the  students,  about  5.5% 
of  interns  and  1%  of  residents  plan  to 
engage  in  family  practice.  It  is  quite  ob- 
vious that  the  backbone  of  our  present 
medical  care  delivery  system,  the  general 
practitioners,  are  not  going  to  be  replaced 
when  they  cease  practice. 

Three  hundred  and  thirty  students 
(55%)  182  interns  (72%)  and  364  resi- 
dents (66%)  have  selected  their  respective 
specialties.  Thirty-one  per  cent  of  students, 
22%  of  interns  and  25%  of  residents  chose 
internal  medicine  or  one  of  its  sub-special- 
ties. Twenty-three  per  cent  of  students,  19% 
of  interns  and  17.5%  of  residents  chose 


some  branch  of  surgery.  Obstetrics-gyne- 
cology, psychiatry  and  radiology  scored 
about  equal,  with  each  specialty  being 
chosen  by  about  1%  of  the  students,  interns 
and  residents.  The  remaining  trainees’  in- 
terests were  divided  in  about  15  other  spe- 
cialties. 

The  next  question  was: 


594  Students 


Do  you  plan  to 

Yes 

No 

No  answer 

practice  solo? 

87 

331 

176 

(14.6%) 

(56.0%)  (29.0%) 

Join  a group? 

(W^0%) 

52 

169 

252  Interns 

Do  you  plan  to 

Yes 

No 

No  answer 

practice  solo? 

37 

114 

101 

(14.7%) 

(45.0%) 

Join  a group? 

1TQ 

(55.0%) 

21 

92 

550  Residents 

Do  you  plan  to 

Yes 

No 

No  answer 

practice  solo? 

(So%) 

310 

158 

Join  a group? 

^21 

(58.0%) 

71 

158 

The  percentage  of  those  who  plan  to 

practice  solo  is  remarkably 

consistent 

throughout  the 

training 

group  (about 

15%).  Also,  the 

percentage 

: of 

those  who 

would  have  decided  to  join  a group  remains 
fairly  consistent  throughout  training,  (55 
to  60%).  It  is  also  true  that  roughly  25% 
have  either  not  made  up  their  minds  or  are 


fi02 


Illinois  Medical  Journal 


191 


going  into  research,  teaching,  administra- 
tion, or  industrial  medicine. 

The  next  question  was: 

If  you  plan  to  do  solo  practice  do  you 

594  Students 


Plan  to  practice 

Yes 

No 

No  answer 

in  a ci  y 

79 

68 

447 

Go  to  a medium- 

sized  town 

89 

51 

454 

Settle  in  a 

rural  area 

32 

74 

488 

If  you  plan  to  do  solo  practice  do  you 

252  Interns 


A. 

Plan  to  practice 

Yes 

No 

No  answer 

B. 

in  a city 
Go  to  a medium- 

40 

21 

191 

C. 

sized  town 
Settle  in  a 

26 

27 

199 

rural  area 

6 

37 

210 

If  you  plan  to  do  solo  practice  do  you 

550  Residents 


A.  Plan  to  practice 

Yes 

No 

No  answer 

in  a city 

105 

40 

405 

B.  Go  to  a medium 

sized  town 

76 

49 

425 

C.  Settle  in  a 

rural  area 

106 

75 

369 

In  retrospect  the  question 

was 

not  a very 

good  one;  but  when  the  questionnaire  was 

circulated  it  was 

believed  most 

graduates 

would  embrace  solo  practice.  The  primary 
purpose  of  the  question  was  to  learn  what 
we  could  expect  of  the  future  distribution 
of  physicians  throughout  the  state.  The  an- 
swers to  this  question  (considering  the  great 
number  that  didn’t  answer  it  at  all)  con- 
firms the  answers  to  the  previous  question 
emphasizing  that  most  future  doctors  are 
interested  in  joining  a group.  It  further 
suggests  that  many  young  doctors  might  be 
interested  in  proceeding  to  a medium-size 
town. 

The  last  question  was: 


If  you  plan  to  join  a group  would  you  prefer 
one  organized  as 

594  Students 


A.  Medical 

Yes 

No  No  answer 

corporation 

261 

(44.0%) 

63 

(10.0%) 

270 

B.  Partnership 

119 

(20.0%) 

113 

(18.0%) 

362 

C.  Foundation 

D.  No  legal  organi- 

zation-sharing 

58 

(10.0%) 

141 

(23.7%) 

395 

facilities 

74 

(12.0%) 

141 

(23.7%) 

379 

If  you  plan  to  join  a group  would  you  prefer 
one  organized  as 

252  Interns 

Yes  No  No  answer 

A.  Medical 

corporation  107  16  129 

(42.0%) 

B.  Partnership  49  37  166 

(19.0%)  (14.0%) 


C.  Foundation  14  47 

(0.6%)  (18.0%) 

D.  No  legal  organi- 

zation-sharing 
facilities  17  49  186 

(0.6%)  (19.0%) 


If  you  plan  to  join  a group  would  you  prefer 
one  organized  as 

550  Residents 


A.  Medical 

Yes 

No  No  answer 

corporation 

241 

(44.0%) 

42 

(7.6%) 

267 

B.  Partnership 

107 

(19.4%) 

71 

(12.8%) 

372 

C.  Foundation 

D.  No  legal  organi- 

zation-sharing 

48 

(6.6%) 

(17.6%) 

404 

facilities 

45 

(6.5%) 

106 

(19.0%) 

399 

It  would  appear  that  of  those  who  plan 
to  join  a group,  a greater  percentage  would 
choose  a corporate  structure.  Many  are  in- 
terested in  a partnership. 

One  purpose  of  the  questionnaire  was  to 
try  to  get  some  idea  of  the  effectiveness  of 
our  campaign  to  obtain  more  doctors  for 
Illinois,  particularly  generalists,  for  the 
downstate  areas.  Of  the  5,000  students,  in- 
terns and  residents,  a significant  sample  (1, 
.S96  or  28%)  answered  the  questionnaire. 
Although  the  plans  of  the  young  often 
change  as  they  mature,  they  are  significant 
and  usually  fulfilled.  Therefore,  I believe 
we  may  gain  certain  guidelines  from  these 
answers. 

Although  we  learn  that  only  30%  of  those 
in  training  in  Illinois  plan  to  practice  in 
the  state,  we  do  get  some  physicians  from 
other  training  areas.  Our  record  is  roughly 
that  we  license  about  half  as  many  doctors 
as  we  graduate  students  in  our  medical 
schools. 

I believe  the  answers  to  our  questionnaire 
make  it  clear  that  we  can  expect  few  to  be- 
come general  practitioners,  and  certainly 
few  generalists  are  going  into  rural  areas, 
where  the  need  is  greatest.  It  is  encourag- 
ing, however,  that  many  plan  to  go  to  a 
“medium-sized  town,”  or  even  to  a rural 
area  as  a specialist. 

Of  great  significance  is  the  anticipation 
they  have  of  joining  a group.  This  is  very 
encouraging  and  supports  my  thought  that 
the  only  way  to  get  new,  young  doctors  to 
practice  outside  the  great  cities  is  to  estab- 
lish gt'oup  practice  units  in  smaller  towns. 
Such  units  would  be  owned  and  controlled 
by  the  physician  members.  The  establish- 
ment of  groups  of  this  type  is  urgent,  since 
there  are  plans  for  “closed  panel”  group 
practice  units  throughout  the  state,  owned 
and  controlled  by  “not-for-profit”  lay 
organizations. 


for  December,  1970 


603 


NEW 

PHARMACEUTICAL 

SPECIALTIES 

by  Paul  deHaen 


For  detailed  information  regarding  indica- 
tions, dosage,  contraindications,  and  adverse 
reactions,  refer  to  the  manufacturer’s  package 
insert  or  brocfiure. 

Single  Chemicals:  Drugs  not  previously  known, 
including  new  salts. 

Duplicate  Single  Products:  Drugs  marketed  by 
more  than  one  manufacturer. 

Combination  Products:  Drugs  consisting  of  two 
or  more  active  ingredients. 

New  Dosage  Forms:  Of  a previously  introduced 
product. 

The  following  new  drugs  have  been  marketed: 

NEW  SINGLE  CHEMICAL 

DIAPID  Nasal  Spray  Antidiuretics  It 

Manufacturer:  Sandoz  Pharmaceuticals 
Nonproprietary  name:  Lypressin 
Indications:  Control  or  prevention  of  symptoms 
and  complications  of  diabetes  insipidus  due  to 
deficiency  of  endogenous  posterior  pituitary 
antidiuretic  hormone. 

Contraindications:  None  known 
Dosage:  1 or  2 sprays  to  one  or  both  nostrils 
whenever  frequency  of  urination  increases  or 
significant  thirst  develops.  Usual  dose  is  1 or 
2 sprays  in  each  nostril  q.i.d. 

Supplied:  Plastic  squeeze  bottle,  0.185  mg./cc 
(Equivalent  to  50  U.SP.  Posterior  Pituitary 
Units) 

DUPLICATE  SINGLE  PRODUCTS 

DEXA-SEQUELS  Antiobesity  preparations — 
Amphetamines  It 

Manufacturer:  Lederle 

Nonproprietary  name:  Dextroamphetamine  sul- 
fate 

Indications:  Exogenous  obesity,  as  a short  term 
adjunct  in  weight  reduction  based  on  caloric 
restriction. 

Contraindications:  Advanced  arteriosclerosis, 
symptomatic  cardiovascular  disease,  moderate 
to  severe  hypertension,  hyperthyroidism, 
known  hypersensitivity  or  idiosyncrasy  to  the 
sympathomimetic  amines,  agitated  states,  pa- 
tients with  a history  of  drug  abuse.  During  or 
within  14  days  following  administration,  hyper- 
tensive crises  may  result. 

Dosage:  One  capsule  in  the  morning  unless  daily 
routine  differs  from  normal  (e.g.  persons  work- 
ing night  shift) . 

Supplied:  Capsules,  10  and  15  mg.. 

Sustained  release 

DIGOXIN  Cardiotonic  R 

Manufacturer:  Lederle 
Nonproprietary  name:  Digoxin 
Indications:  Congestive  heart  failure,  atrial  fi- 
brilation,  atrial  flutter,  supraventricular  tachy- 
cardia and  premature  extrasystoles.  Refractory 
ventricular  paroxysmal  tachycardia. 

Dosage:  Adults  and  children  over  10  years: 
Rapid  digitalization:  1.5  mg.  initially  followed 
by  0.25  to  0.5  mg.  every  6 hrs.  Average  total 
dose,  2 to  3 mg. 

(iOt 


Slow  digitalization:  0.5  to  1.0  mg.  daily  for  ap- 
proximately one  week  followed  by  appropriate 
maintenance  dosage  for  a period  of  1 to  3 
weeks.  Usual  maintenance  dosage,  0.25  to  0.75 
mg. 

Supplied:  Tablets,  0.25  mg. 

ECTASULE-MINUS  Nasal  decongestant 
JR  & SR  Bronchodilator  R 

Manufacturer:  Fleming 
Nonproprietary  name:  Ephedrine  sulfate 
Indications:  Hay  fever  patients  who  complain  of 
drowsiness  from  antihistamines. 
Contraindications:  Use  with  caution  in  cardiac 
and  vascular  diseases,  hyperthyroidism,  circu- 
latory collapse  and  prostatitis. 

Dosage:  One  capsule  every  12  hrs.  or  in  severe 
cases  every  8 hrs. 

Supplied:  Capsules,  30  and  60  mg. 

HAUTOSONE  Dermatological  preparation  R 
Manufacturer:  Hautarts,  Div.  Fellows  Med.  Mfg. 
Co.,  Inc. 

Nonproprietary  name:  Hydrocortisone 
Indications:  Various  susceptible  dermatoses 
Contraindications:  Tuberculosis,  fungus  and  most 
viral  lesions,  including  herpes  simplex,  vari- 
cella and  vacinnia.  Not  intended  for  ophthal- 
mic use. 

Dosage:  Apply  to  lesion  and  massage  in,  2 to  4 
times  daily.  One  to  two  drops  will  cover  2 to 
4 square  inches. 

Supplied:  Solution  0.5% 

COMBINATION  PRODUCTS 

EPICAR  Ophthalmic  solution  R 

Manufacturer:  Barnes-Hind 
Composition:  Pilocarpine  HCl  1%,  2%,  3%,  4%, 
or  6% 

Epinephrine  HCl  0.65% 

Indications:  Control  of  simple  open-angle  glau- 
coma 

Contraindications:  Narrow-angle  glaucoma  and 
sensitivity  to  pilocarpine  and/or  epinepherine. 
Dosage:  One  or  two  drops  in  eye  every  6 to  8 hrs. 
Supplied:  Dropper  vials,  15  cc 

KINESED  G.I.  preparation 
Manufacturer:  Stuart 
Composition:  Phenobarbital 

Hyosyamine  Sulfate 
Atropine  Sulfate 
Scopolamine  HBr 
Simethicone 

Indications:  Symptomatic  relief  in 
gastrointestinal  disorders. 

Contraindications:  Hypersensitivity 
na  alkaloids  or  barbiturates. 

Dosage:  Adults:  One  or  two  tablets  3 or  4 times 
daily 

Children  2-12  yrs.:  % tablet  3 or  4 times  daily 
Supplied:  Tablets,  fruit-flavored,  chewable 

KORYZA  Cold  preparation  R 

Manufacturer:  Fellows  Testagar  Div.  of  Fellows 


Med.  Mfg.  Co.,  Inc. 


Composition:  Phenylephrine  HCl 

15 

mg. 

Phenylprobanolamine  HCl 

25 

mg. 

Chlorpheniramine  Maleate 

4 

mg. 

Acetaminophen 

300 

mg. 

Hyoscyamine  HBr 

0.134 

mg. 

Hyoscine  HBr 

0.008 

mg. 

Atropine  Sulfate 

0.020 

mg. 

Indications:  Temporary  relief  of 

respiratory 

symptoms. 

Contraindications:  Glaucoma,  asthma,  hepatitis, 
pregnancy  toxemias,  pyloric  obstruction,  pros- 
tatic hypertrophy  and  intolerance  to  any  of 
the  classes  of  drugs  included. 


R 

16  mg. 

0.1  mg. 
0.02  mg. 
0.007  mg. 
40  mg. 

a variety  of 

to  belladon- 


fllinois  Medical  Journal 


Dosage:  One  tablet  every  3 or  4 hrs. 

Supplied:  Tablets 

NICOL  Tablets  Cold  preparation  IJ 

Manufacturer:  Warner-Cliilcott 

Composition:  Phenylpropanolamine  HCl  50  mg. 

Chlorpheniramine  maleate  4 mg. 

Glyceryl  guaiacolate  200  mg. 

Dextromethorphan  HBr  30  mg. 

Indications:  Temporary  relief  of  respiratory 

symptoms. 

Contraindications:  Hypersensitivity  to  any  in- 
gredient 

Dosage:  Adults:  One  tablet  3 or  4 times  a day. 
Children  6-12:  One-half  tablet  3 or  4 times  a 
day 

Supplied:  Tablets 


PRAMET  FA  Vitamins-Prenatal 
Manufacturer:  Ross 

o-t-c 

Composition:  Iron  (as  Ferrous  Sulfate)  60 

mg. 

Folic  Acid 

1 

mg. 

Vitamin  A Acetate  (4000  Units) 
Vitamin  D.,  (400  Units 

1.2 

mg. 

Ergocalciferol) 

10 

meg. 

Vitamin  C (Ascorbic  Acid) 

100 

mg. 

Vitamin  B^  (Thiamine  Mononitrate)  3 

mg. 

Vitamin  Bo  (Riboflavin) 

2 

mg. 

Vitamin  B^j  (Pyridoxine  HCl) 

5 

mg. 

Vitamin  B^2  (Cyanocobalamin) 

3 

meg. 

Niacinamide  (as  Niacinamide  HCl) 

10 

mg. 

d-Calcium  Pantothenate 

1 

mg. 

Iodine  (as  Calcium  lodate) 

0.1 

mg. 

Calcium  (as  Calcium  Carbonate) 

250 

mg. 

Copper  (as  Cupric  Chloride) 

0.15 

mg. 

Indications:  Nutritional  supplementation  during 

pregnancy 

Contraindications:  None  mentioned 
Dosage:  One  tablet  daily  or  as  directed  by  phy- 
sician 

Supplied:  Tablets 

NEW  DOSAGE  FORM 

ALPEN  Penicillin  & Deriv.  IJ 


Manufacturer:  Lederle 

Nonproprietary  name:  AmpicUlin  trihydrate 
Indications:  Treatment  of  infections  due  to  sus- 
ceptible strains  of  gram-negative  and  gram- 
positive organisms. 

Contraindications:  History  of  allergic  reaction 
to  any  of  the  penicillins 
Dosage:  Adults:  250-500  mg.  every  6-8  hrs. 
Children:  50-100  mg./kg./day  in  divided  doses 
every  6-8  hrs. 

Supplied:  Oral  suspension,  125  and  250  mg./5  cc. 

COLY-MYCIN  M Parenteral  Antibiotics— 

B & M Spectrum  IJ 

Manufacturer:  Warner- ChUcott 
Nonproprietary  name:  Colistimethate  sodium 
Indications:  Acute  or  chronic  infections  due  to 
sensitive  strains  of  gram-negative  bacilli. 
Contraindications:  Patients  with  history  of  sensi- 
tivity to  the  drug.  Safety  during  pregnancy 
has  not  been  established.  Daily  dose  should  be 
reduced  in  the  presence  of  renal  impairment. 
Dosage:  i.v.  or  i.m.,  2 to  4 divided  doses  of  2.5 
to  5 mg. /kg.  per  day. 

Supplied:  Vials,  20  or  150  mg.  colistin  base  ac- 
tivity per  vial  as  a lyophilized  cake. 

NICOL  Elixir  Cold  preparation  R 

Manufacturer:  Warner-ChUcott 
Composition:  Each  15  cc  contains: 

Phenylpropanolamine  HCl  25  mg. 

Chlorpheniramine  maleate  2 mg. 

Glyceryl  guaiacolate  100  mg. 

Dextromethorphan  HBr  15  mg. 

Alcohol  10% 

Indications:  Temporary  relief  of  respiratory 

symptoms 

Contraindications:  Hypersensitivity  to  any  in- 
gredient 

Dosage:  Adults:  Two  tbs.  3 or  4 times  daily 

Children  6-12:  One  tb'!.  3 or  4 times  daily 
4-6:  Two  tsp.  3 or  4 times  daily 
2-4:  One  tsp.  3 or  4 times  daily 

Supplied:  Elixir 


New  voluntary  product  standard 
for  clinical  thermometers  approved 


A new  Voluntary  Product  Standard,  PS 
39-70,  “Clinical  Thermometers  (Maximum- 
Self-Registering,  Mercury-In-Gla'ss)”  has 
been  approved  for  publication  by  the  Na- 
tional Bureau  of  Standards,  U.  S.  Depart- 
ment of  Commerce,  with  an  effective  date 
of  October  15,  1970.  The  standard  was  proc- 
essed as  a revision  of  Commercial  Standard 
CS  1-52  in  accordance  with  the  “Procedures 
for  the  Development  of  Voluntary  Product 
Standards”  published  by  the  U.  S.  Depart- 
ment of  Commerce. 

The  purpose  of  this  standard  is  to  estab- 
lish nationally  recognized  classifications  and 
performance  requirements  for  thermometers 
which  are  used  to  measure  body  tempera- 
tures, including  temperatures  to  be  used 


for  determining  date  of  ovulation  and 
basal  metabolic  rate.  Included  are  require- 
ments for  bulb  and  stem  glasses,  tempera- 
ture scale  graduations,  accuracy,  ease  of 
resetting,  and  retention  of  temperature 
indications. 

Printed  copies  of  the  standard  will  be 
available  from  the  U.  S.  Government  Print- 
ing Office,  Washington,  D.C.  20402  in  three 
or  four  months.  In  the  meantime,  the  rec- 
ommended standard,  designated  TS  151c, 
“Clinical  Thermometers  (Maximum-Self- 
Registering,  Mercury-In-Glass),”  may  be 
used.  Copies  of  TS  151c  are  available  with- 
out charge  from  the  Office  of  Engineering 
Standards  Services,  National  Bureau  of 
Standards,  Washington,  D.C.  20234. 


for  December,  1970 


605 


Clinics  for  Crippled  Children  Scheduled 


Twenty-three  clinics  for  Illinois’  physi- 
cally handicapped  children  have  been 
scheduled  for  January  by  the  University 
of  Illinois,  Division  of  Services  for  Crippled 
Children.  The  Division  will  hold  nineteen 
general  clinics  providing  diagnostic  ortho- 
pedic, pediatric,  speech  and  hearing  ex- 
amination along  with  medical  social,  and 
nursing  service.  There  will  be  three  special 
clinics  for  children  with  cardiac  conditions 
and  rheumatic  fever,  and  one  for  children 
with  cerebral  palsy.  Clinicians  are  selected 
from  among  private  physicians  who  are 
certified  Board  members.  Any  private  phy- 
sician may  refer  or  bring  to  a convenient 
clinic  any  child  or  children  for  whom  he 
may  want  examination  or  consultative 
services. 

Jan.  6— Hinsdale— Hinsdale  Sanitarium 
Jan.  7— Sterling— Community  General 
Hospital 

Jan.  7— Flora— Clay  County  Hospital 
Jan.  7— Cairo— Public  Health  Department 
Jan.  8— Chicago  Heights  Cardiac  — St. 
James  Hospital 

Jan.  12— East  St.  Louis— Christian  Welfare 
Hospital 

Jan.  12— Peoria  General— St.  Francis  Chil- 
dren’s Hospital 

Jan.  13— Champaign-Urbana  — McKinley 
Hospital 

Jan.  13— Elgin— Sherman  Hospital 
Jan.  13— Joliet— St.  Joseph’s  Hospital 
Jan.  14— Springfield  General  — St.  John’s 
Hospital 

Jan.  14— Macomb  — McDonough  District 
Hospital 

Jan.  14— Decatur— Decatur  Memorial  Hos- 
pital 


Jan.  19— Quincy— Blessing  Hospital 
Jan.  19— Rock  Island  General— Moline  Pub- 
lic Hospital 

Jan.  20— Evergreen  Park— Little  Company 
of  Mary  Hospital 

Jan.  21— Rockford  — Rockford  Memorial 
Hospital 

Jan.  21— Elmhurst  Cardiac— Memorial  Hos- 
pital of  DuPage  County 
Jan.  22— Chicago  Heights  Cardiac  — St. 
James  Hospital 

Jan.  26— Peoria  General— St.  Francis  Ghil- 
clren’s  Hospital 

Jan.  27— Springfield  Pediatric  Neurology- 
Diocesan  Center 

Jan.  27— Mt.  Vernon— Good  Samaritan  Hos- 
pital 

Jan.  27— Centralia— St.  Mary’s  Hospital 
The  Division  of  Services  for  Crippled 
Children  is  the  official  state  agency  estab- 
lished to  provide  medical,  surgical,  correc- 
tive, and  other  services  and  facilities  for 
diagnosis,  hospitalization  and  after-care  for 
children  with  crippling  conditions  or  who 
are  suffering  from  conditions  that  may  lead 
to  crippling. 

In  carrying  on  its  program,  the  Divi- 
sion works  cooperatively  with  local  medical 
societies,  hospitals,  the  Illinois  Children’s 
Hospital-School,  civic  and  fraternal  clubs, 
visiting  nurse  association,  local  social  and 
welfare  agencies,  local  chapters  of  the  Na- 
tional Foundation  and  other  interested 
groups.  In  all  cases,  the  work  of  the  Di- 
vision is  intended  to  extend  and  supple- 
ment, not  supplant  activities  of  other  agen- 
cies, either  public  or  private,  state  or  local, 
carried  on  in  behalf  of  crippled  children. 


SOS  offers  a new  ^%ick  the  cigarette  hahif^  approach 

SOS  is  the  rescue  ship  for  the  distress  call  of  those  smok- 
ers who  need  a proven  method  to  kick  the  cigarette  habit. 

The  SNUFFED  OUT  SYSTEM  (SOS)  heralds  a brand 
new  approach  to  the  problem  of  how  to  quit  smoking. 

Using  the  tools  contained  in  the  recently  published 
book.  Snuffed  Out,  the  results  are  positive  and  successful 
SOS’ers  testify  to  the  success  of  the  approach. 

The  book.  Snuffed  Out,  is  rapidly  becoming  the  daily 
companion  of  SOS’ers  and  the  key  that  opened  the  lock 
to  stop  smoking  forever.  Gost  is  .'$1.00  plus  35^  for  postage 
and  handling  to:  SNUFFED  OUT,  Box  236MM  South 
Elgin,  Illinois  60177. 


60G 


Illinois  Medical  Journal 


Looking  for  a Place  to  Practice? 
Placement  Service  Lists  Openings 


In  an  effort  to  reduce  the  number  of 
towns  in  Illinois  needing  practicing  physi- 
cians, the  Journal  is  publishing  synopses 
submitted  to  the  Physicians  Placement 
Service  concerning  openings  for  doctors. 

Physicians  who  are  seeking  a place  to 
practice  or  who  know  of  any  out-of-state 
physicians  seeking  an  Illinois  residence  are 
asked  to  notify  the  placement  service. 

Information  and  comments  are  also  re- 
quested from  physicians  living  near  the 
communities  listed  as  to  the  real  need  and 
the  ability  of  the  town  to  support  addi- 
tional physicians. 

Inquiries  and  comments  should  be  di- 
rected to  Mrs.  Robert  Swanson,  Secretary, 
Physicians  Placement  Service,  Illinois  State 
Medical  Society,  360  N.  Michigan  Ave., 
Chicago  60601. 

Subsequent  to  the  listings  over  the  past 
30  months,  the  following  supplemental  list 
of  openings  is  furnished.  This  will  be  con- 
tinued next  month. 

HENRY  COUNTY:  Kewanee;  population: 
18,000.  Trade  area:  35,000.  New  medical 
center  across  from  150  bed  Community 
Hospital.  Suite  of  1000  sq.  ft.  available 
for  immediate  occupancy.  Reasonable  rent. 
Solo  practice.  Ten  physicians  in  communi- 
ty. Agriculture  and  industry.  Catholic  and 
Protestant  churches.  Six  grade  schools;  two 
high  schools.  Local  junior  college.  Country 
club.  Two  golf  courses.  For  further  infor- 
mation contact:  William  Neilson,  M.D., 
716  Elliott  Street,  Kewanee.  Phone:  2263. 

MADISON  COUNTY:  Collinsville;  popu- 
lation: 21,000.  Position  available  immedi- 
ately. Young  man  willing  to  take  over 
practice  and  go  into  partnership  with  long 
range  plan  of  completely  assuming  prac- 
tice. Minimum  starting  salary:  |12,000 

monthly.  No  investment  necessary.  Oppor- 
tunity for  partnership  after  one  year.  Com- 
plete physiotherapy,  EKG,  BMR  and  lab. 
Eleven  GPs  in  community.  Four  nearby 
hospitals.  For  further  information  contact: 
Morris  Rothenberg,  M.D.,  217  W.  Clay  St., 
Collinsville.  Phone:  344-0090. 


MARSHALL  COUNTY:  Lacon;  popula- 
tion: 2300.  Opening  for  GP  or  surgeon. 
Lacon  Clinic— two  physicians.  Full  partner- 
ship after  three  years.  Use  three  Peoria 
hospitals;  2000  beds.  Agriculture  and  }8cL 
Steel  Co.  Protestant  and  Catholic  churches. 
Public  schools.  Country  club  with  golf 
course  and  pool.  For  further  information 
contact:  Merle  Swearingen,  M.D.,  202  S. 
Main,  Lacon  61450. 

McHenry  county:  Crystal  Lake;  pop- 
ulation: 14,000.  Trade  area:  63,000.  Ten 
practicing  physicians.  Nearest  hospital  at 
McHenry,  eight  miles.  Five  drug  stores. 
New  and  older  offices  available;  new  clinic 
also  available.  Sixteen  churches;  seven 
grade  schools,  one  high  school.  Local  and 
international  organizations.  Three  golf 
courses;  lake;  exceptional  parks.  Popula- 
tion nearly  doubled  in  last  10  years.  For 
further  information  contact:  John  Boehner, 
Chamber  of  Commerce,  Box  256,  Crystal 
Lake. 

RANDOLPH  COUNTY:  Tilden;  popula- 
tion: 1000.  Trade  area:  16,000.  Nearest 
physicians,  six  miles.  Town  without  a phy- 
sician for  many  years.  Fifty  miles  from  St. 
Louis.  New  office  being  provided  by  citi- 
zens. Home  rent  free  for  one  year;  office 
for  two  years.  Predominant  nationalities: 
German  and  Irish.  Agriculture,  industry 
and  coal  mining.  Three  churches.  Grade 
and  high  schools.  Golf  course.  For  further 
information  contact:  Lawrence  Campbell, 
Box  201,  Tilden.  Phone:  618-587-2061. 

SANGAMON  COUNTY:  Illiopolis;  popu- 
lation; 1,200.  Located  halfway  between 
Springfield  and  Decatur.  Only  physician 
died  recently.  Two  factories.  Population  of 
nearby  Decatur,  100,000.  Previous  physi- 
cian’s office  available  if  desired.  Agricul- 
ture and  industry.  Four  Protestant  and 
Catholic  churches.  Grade  and  high  schools. 
College  in  Decatur.  Four  country  clubs. 
Four  hospitals  available.  For  further  infor- 
mation contact:  Mr.  R.  E.  McDermott,  345 
Fifth  St.,  Illiopolis.  Phone:  217-486-2721. 


for  December,  1970 


607 


LIBRARY 


Emergency  Room  Journal  Articles.  Edit- 
ed by  Abraham  Gelperin,  M.D.,  Dr.P.H., 
M.S.H.A.,  and  Eve  Arlin  Gelperin,  R.N., 
B.S.  Medical  Examination  Publishing 
Co.,  Inc.  Elushing,  New  York.  248  pages. 
$8.00. 

This  volume  is  a compilation  of  50  of  the 
most  recent  pertinent  journal  articles  re- 
lated to  the  theory  and  practice  of  running 
an  emergency  room.  It  will  prove  extremely 
useful  to  all  physicians,  nurses  and  admin- 
istrators involved  in  the  organization  of 
this  department. 

Outpatient  Services  Journal  Articles. 
Edited  by  Vivian  Vreeland  Clark,  R.N., 
Ed.D.  Medical  Examination  Publishing 
Co.,  Inc.,  blushing.  New  York.  318  pages. 
$8.00. 

Ehis  volume  is  a compilation  of  50  of 
the  most  recent  pertinent  journal  articles 
related  to  outpatient  services.  It  is  an  up- 
to-date  review  of  the  current  thinking  in 
this  field,  in  one  concise,  easy-to-read  man- 
ual, thereby  eliminating  time-consuming 
research  for  new  ideas  and  innovations. 

Articles  have  been  grouped  as  follows; 
1)  The  Ambulatory  Clinic  Patient  & His 
Needs;  2)  Problems,  Issues  & Observations 
on  the  Delivery  of  Ambulatory  Health 
Services;  3)  Patterns  & Examples  of  Ambu- 
latory Clinic  Services;  4)  Multiphasic 
Screening;  5)  Health  Services  Personnel  in 
Ambulatory  Clinics. 

After  Vagotomy.  Edited  by  J.  Alexander 
Williams  and  Alan  G.  Cox.  Appleton- 
Century-Crofts.  New  York,  1969. 

This  book  is  an  attempt  to  assess  the 
effect  of  vagotomy  which  has  been  used  in 
the  treatment  of  peptic  ulceration  for  just 
over  tweiity-five  years.  The  authors  of  the 
volume  are  authorities  in  the  field  and  com- 
bine British- investigators  with  authorities 


from  the  United  States.  An  eloquent  fore- 
word is  provided  by  Dr.  Francis  D.  Moore 
of  Harvard,  and  contributors  from  the 
United  States  include  Drs.  Walter  Ballinger, 
Irving  Enquist,  Ward  Griffen  and  William 
Silen. 

The  book  is  divided  into  six  sections 
which  deal  with  the  pathophysiology  of 
vagotomy,  results  of  vagotomy,  complica- 
tions of  vagotomy,  practical  problems,  spe- 
cial indications,  and  vagotomy  and  after. 

The  volume  is  a careful  compendium  of 
the  effects  of  vagal  nerve  section  and  in- 
cludes a careful  assessment  of  unresolved 
problems.  Appropriate  tables  and  illustra- 
tions are  included  to  document  the  mate- 
rial in  the  text.  Perhaps,  one  of  the  most 
important  contributions  that  the  authors 
make  in  the  book  is  to  indicate  areas  in 
which  understanding  of  the  effects  of  the 
vagal  nerve  and  vagal  nerve  sections  re- 
mains uncertain.  Each  chapter  has  an  ap- 
propriate set  of  references. 

The  book  should  be  useful  to  students  of 
gastrointestinal  physiology  and  to  clinicians 
interested  in  the  treatment  of  peptic  ulcera- 
tion. 

John  M.  Beal,  M.D. 

Illustrated  Laboratory  Techniques.  Edit- 
ed by  Nozomu  Kosakai,  M.D.  Medical 
Examination  Publishing  Co.,  Inc.,  Flush- 
ing, New  York.  230  pages,  308  illustra- 
tions (23  colored).  $10.00. 

Recent  advances  in  laboratory  techniques 
have  resulted  in  increasing  numbers  of 
laboratory  tests  being  performed  in  doc- 
tors’ offices.  This  book  is  a simple  guide  to 
enable  office  personnel  to  perform  routine 
laboratory  procedures  with  little  supervi- 
sion. It  is  a valuable  asset  for  the  doctor’s 
office,  as  well  as  medical  laboratories. 


608 


Illinois  Medical  Journal 


The  Fifth  Horseman— Drug  addiction 


One  of  the  most  frightening  problems  of 
this  decade  is  the  continued  spread  of  nar- 
cotic addiction  in  the  United  States.  The 
emphasis  on  the  dangers  of  taking  drugs 
as  a method  of  dissuading  teenagers  from 
their  use  has  been  judged  a failure  by  the 
National  Institute  of  Mental  Health.  Lec- 
tures from  authorities  such  as  the  police, 
physicians,  ex-narcotic  addicts  and  others 
have  not  proved  to  be  effective.  One  key 
to  the  problem  is  the  teenager  in  junior 
high  school  or  freshman  entering  high 
school  who  opposes  drugs.  A personal  sur- 
vey of  over  100  thirteen  and  fourteen-year- 
olds  in  my  community  showed  the  ma- 
jority to  be  actively  opposed  to  taking 
drugs.  The  most  common  answers  were 
that  taking  drugs  was  “dumb”  or  “stupid.” 
After  four  years  of  unremitting  pressure 
from  the  organized  drug  using  forces  with- 
in the  high  schools,  the  percentage  of  col- 
lege freshmen  who  state  that  taking  drugs 
is  dumb  or  stupid  is  distressingly  small. 

One  way  to  combat  drug  addiction  is  to 
have  teenagers  who  oppose  the  use  of  drugs 
form  anti-drug  study  groups  in  every  high 
school.  Teachers  and  principals  generally 


have  not  utilized  this  approach  in  combat- 
ting the  menace  of  drug  addiction.  The 
establishment  of  anti-drug  study  groups 
will  require  the  advice  and  encouragement 
of  school  authorities,  but  in  order  to  be  ef- 
fective, the  students  themselves  who  are 
opposed  to  taking  drugs  must  be  free  to 
control  and  administer  them.  The  anti- 
drug study  group  must  be  free  to  invite 
outside  authorities  to  educate  and  inform 
the  group.  The  group  would  invite  and  at- 
tempt to  w'in  the  minds  of  the  uncommit- 
ted teenagers  to  the  anti-drug  group.  The 
important  thing  is  the  anti-drug  - study 
group  will  provide  a counter  peer  group  as 
a rallying  point  for  teenagers  who  oppose 
taking  drugs. 

In  this  way  a mental  vaccine  against  the 
spread  of  narcotic  addition  can  be  given 
to  large  numbers  of  teenagers  to  develop 
resistance  against  the  drug  users. 

Narcotic  addiction  is  the  apocolyptic  fifth 
horseman  who  is  abroad  in  the  land.  We 
must  stand  and  oppose  this  menace  with 
every  resource  at  our  command. 

Harvey  Kravitz,  M.D. 


When  What  Goes  Down  Comes  Up 

They  say  what  goes  up  must  come  down.  But  the  government  can  make 
what  goes  down  come  up— when  -it  "seasonally  adjusts"  unemployment  figures. 
Last  May,  unemployment  DROPPED  170,000.  But  because  it  did  not  drop  as 
much  as  it  normally  does  from^  April  to  May,  BLS  reported— and  all  the  scare 
headlines  proclaimed— that  it  ROSE  from  4.8  to  5%! 


for  I^ecember,  1970 


609 


Hearing 

conservation 

endorsed 

by 

ISMS 

The  problems  associated  with  noise  are 
receiving  increased  attention  by  the  public, 
industry,  workers,  state  and  federal  agen- 
cies. As  physicians,  we  are  concerned  with 
the  general  effects  of  noise  and  particularly 
as  it  affects  the  sense  of  hearing. 

The  Chicago  Larynogological  and  Oto- 
logical  Society  is  familiar  with  the  studies, 
recommendations  and  guidelines  made  by 
the  Committee  on  Conservation  of  Hearing 
of  the  American  Academy  of  Ophthal- 
mology and  Otolaryngology  for  conserva- 
tion of  hearing  in  noise.  For  the  past  25 
years,  the  Committee  on  Conservation  of 
Hearing  has  been  investigating  and  study- 
ing the  many  problems  arising  from  noise- 
exposure.  This  Committee  has  published 
the  Guide  for  Conservation  of  Hearing  in 
Noise}  which  offers  a practical  program 
for  the  evaluation  of  noise-  exposure,  means 
of  noise  reduction,  the  use  of  personal  ear 
protection  and  how  to  conduct  hearing 
testing  in  industry.  This  guide  has  been 
prepared  by  knowledgeable  professional 
personnel,  based  upon  their  experiences 
in  the  field  of  otology  and  the  industrial 
environment.  Guidelines  and  regulations 
for  permissible  noise-exposure  in  industry 
have  recently  been  established  by  the  U.S. 
Department  of  Labor.^ 

Hearing  loss  resulting  from  noise-expos- 
ure is  a scheduled  compensable  occupa- 
tional disease  in  the  majority  of  states  and 
Canadian  Provinces.^  It,  therefore,  becomes 
necessary  for  the  physician,  usually  the 
otolaryngologist,  to  evaluate  causal  rela- 
tionship, the  extent  and  degree  of  the  hear- 
ing loss  and  the  percentage  of  hearing 


impairment.  The  American  Medical  Asso- 
ciation has  published  the  Guide  for  the 
Evaluation  of  Permanent  Impairment  of 
the  Ear,  Nose  and  Throat  and  Related 
Structures}  based  upon  the  recommenda- 
tions of  the  Committee  on  Conservation 
of  Hearing.  Workmen’s  Compensation  and 
medical-legal  cases  for  noise  exposure,  are 
also  associated  with  social,  political  and 
economic  problems  which  do  not  call  for 
medical  decisions  or  recommendations. 
Such  matters  as  to  whether  or  not  compen- 
sation is  paid  for  loss  of  hearing,  how  much 
compensation  and  under  what  conditions 
are  decisions  to  be  made  by  the  courts, 
communities  and  legislative  bodies  are 
considered. 

Attention  is  also  directed  to  medical  re- 
sponsibility in  Hearing  Conservation  Pro- 
grams as  described  in  the  Guide^:  “The 
conservation  of  any  human  function  is 
primarily  a medical  responsibility.  Hearing 
consenation  is  no  exception.  Prevention, 
diagnosis  and  treatment  of  hearing  loss, 
validation  and  approval  of  audiometric 
records;  and  the  final  assessment  of  mea- 
surement of  hearing  are  medical  responsi- 
bilities. Any  hearing  conservation  program 
luithout  medical  supervision  must  be  con- 
sidered inadequate/^ 

The  Chicago  Laryngological  and  Oto- 
logical  Society  through  its  Committee  on 
Industrial  Health  endorses  the  above  prin- 
ciples and  guidelines.  It  advocates  their 
use  in  dealing  with  the  problems  arising 
from  noise-exposure. 

In  addition,  the  Ear,  Nose  and  Throat 
Committee  of  the  Illinois  State  Medical  So- 
ciety also  endorses  this  position  and  will 
submit  it  to  the  Board  of  Trustees  at  the 
next  meeting  in  January,  1971,  for  its 
approval. 


References 

1.  Committee  on  Conservation  of  Hearing,  “Guide 
for  Conservation  of  Hearing  in  Noise,”  Trans- 
actions, American  Academy  of  Ophthalmology 
and  Otolaryngology,  Revised  1969. 

2.  Department  of  Labor,  “Safety  and  Health 
Standards,”  Federal  Register,  May  20,  1969,  Vol. 
34,  No.  96,  page  7948. 

3.  Fox,  Meyer  S.,  M.D.,  “Comparative  Provisions 
for  Occupational  Hearing  Loss,”  Arch.  Oto- 
laryng.  March  1965.  Vol.  81,  pp.  257-260,  Up- 
dated 1969— {National  Safety  News,  Feb.,  1970). 

4.  Committee  on  Medical  Rating  of  Physical  Im- 
pairment: “Guide  to  the  Evaluation  of  Perm- 
anent Impairment:  Ear,  Nose,  Throat  and  Re- 
lated Structures,”  JAMA,  Aug.  19,  1961,  177: 
489-501. 


610 


Illinois  Medical  Journal 


Reference  Issue  Correction 


AMA  Delegation 


DELEGAl  ES  TO  THE 
AMERICAN  MEDICAL 
ASSOCIATION 

Elected  May  21,  1968 

(to  serve  from  Jan.  1,  1969  to  Dec.  31,  1970) 
MAURICE  M.  HOELTGEN 

1836  West  87th  Street,  Chicago  60620 
LEO  P.  A.  SWEENEY 

10400  S.  Western  Avenue,  Chicago  60643 
H.  CLOSE  HESSELTINE 

5807  South  Dorchester,  Chicago  60637 
WILLIAM  K.  FORD 

303  North  Main  Street,  Rockford  61101 
JACOB  E.  REISCH 

1129  South  2nd  Street,  Springfield  62704 


Elected  May  21,  1969 

(to  serve  from  Jan.  1,  1970  to  Dec.  31,  1971) 
EDWARD  A.  PISZCZEK 

6410  North  Leona,  Chicago  60646 
HAROLD  A.  SOFIELD 

715  Lake  Street,  Oak  Park  60301 
PHILIP  G.  THOMSEN 

13826  Lincoln,  Dolton  60419 
THEODORE  GREVAS 

1800  Third  Avenue,  Rock  Island  61201 
HARLAN  ENGLISH 

909  North  Logan  Avenue,  Danville  61833 
EDWARD  W.  CANNADY 
4601  State  Street,  East  St.  Louis  62205 


Elected  May  20,  1970 

(to  serve  from  Jan.  1,  1971  to  Dec.  31,  1972) 
Maurice  M.  Hoeltgen 
Francis  W.  Young 
H.  Close  Hesseltine 
Carl  E.  Clark 
Joseph  R.  Mallory 

Honorary 

Edwin  S.  Hamilton,  151  N.  Schuyler  Street, 
Kankakee  60901 

George  F.  Lull,  2440  Lakeview  Ave.,  Chicago 
60614 

Burtis  E.  Montgomery,  37  South  Main  Street, 
Harrisburg  62946 


ALTERNATE  DELEGATES 
TO  THE  AMERICAN 
MEDICAL  ASSOCIATION 

Elected  May  21,  1968 

(to  serve  from  Jan.  1,  1969  to  Dec.  31,  1970) 
THEODORE  R.  VAN  DELLEN 

1000  Lake  Shore  Plaza,  Chicago  60611 
ALLISON  L.  BURDICK,  SR. 

5906  West  North  Avenue,  Chicago  60639 
ARKELL  M.  VAUGHN 

9012  S.  Leavitt  Street,  Chicago  60620 
PAUL  A.  DAILEY 

620  N.  Main  St.,  Carrollton  62016 
JACK  GIBBS 

Coleman  Clinic,  Canton  61520 

Elected  May  21,  1969 

(to  serve  from  Jan.  1,  1970  to  Dec.  31,  1971) 
HERSCHEL  BROWNS 

4600  North  Ravenswood  Ave.,  Chicago  60640 
GEORGE  C.  TURNER 

6627  Ponchartrain  Avenue,  Chicago  60646 
FRANCIS  W.  YOUNG 

9933  S.  Western  Avenue,  Chicago 
MORGAN  M.  MEYER 
573  South  Lombard,  Lombard  60148 
CARL  E.  CLARK 

225  Edward  Street,  Sycamore  60178 
JOSEPH  R.  MALLORY 

Linck  Clinic,  Mattoon  61938 


Elected  May  20,  1970 

(to  serve  from  Jan.  1,  1971  to  Dec.  31,  1971) 
Theodore  R.  VanDellen 
Fred  A.  Tworoger 
Frank  J.  Jirka,  Jr. 

Joseph  R.  O’Donnell 
Jack  Gibbs 

To  fill  unexpired  terms  starting  January  1,  1971. 
William  M.  Lees,  replacing  Francis  W.  Young 
as  alternate 

Boyd  McCracken  replacing  Carl  E.  Clark  as 
alternate 

Glen  E.  Tomlinson  replacing  Joseph  R.  Mallory 
as  alternate 

Delegates 

Walter  C.  Bornemeier,  4665  Peterson  Avenue, 
Chicago  60646 

Delegate — AMA  Section 
Henry  A.  Holle,  1350  N.  Lake  Shore  Drive, 
Chicago  60610 

61 1 


for  December,  1970 


ABSTRACTS  (Continued  from  page  578) 

opposing  any  repeal  of  the  anti-substitution  provision  in  Illi- 
nois. The  Board  accepted,  for  information,  a report  of  the  ISMS 
Committee  on  Drugs  and  Therapeutics  which  took  a more  favorable 
viewpoint  on  this  subject.  The  Pharmacy  Board  action  applies 
only  to  licensure  and  makes  no  alteration  in  ongoing  pharmacy 
practices.  The  effect  of  the  ISMS  action  is  to  call  for  no  change 
in  the  relationship  between  physicians  and  pharmacists  in  the 
matter  of  drug  substitution. 

Student  Activity 

Endorsement  was  given  to  the  continuation  of  the  Medical  Edu- 
cation Community  Orientation  (MECO)  program  for  1971  as  con- 
ducted by  the  Student  American  Medical  Association  (SAMA).  This 
program,  originally  developed  in  Illinois,  has  been  expanded 
to  twenty-three  states.  One  hundred  and  forty-one  students  were 
involved  in  fifty-four  hospitals  in  Illinois  during  1970.  An 
Evaluation  Conference,  to  be  held  in  Chicago,  January  1971,  was 
approved  in  principle.  The  Board  recommended  to  the  Finance  Com- 
mittee, inclusion  of  |1,000  in  the  SAMA  Advisory  Committee  bud- 
get for  1971  to  assist  with  the  Conference  and  suggested  that  the 
SAMA  Committee  seek  additional  sources  of  revenue.  The  Confer- 
ence will  bring  together  the  program  participants,  representa- 
tives of  the  hospitals  involved  and  others.  Staff  support  for  the 
MECO  project  and  the  Evaluation  Conference  will  be  provided. 

In  related  action,  the  Board  requested  the  Illinois  delegates 
to  AMA  to  introduce  a resolution  at  the  forthcoming  Clinical 
Session  in  Boston  directing  the  AMA  Council  on  Medical  Education 
to  study  the  MECO  project  and  consider  recommendations  to  medi- 
cal schools  for  granting  elective  credit  for  participation  in 
this  program. 

A recommendation  that  students  assigned  to  ISMS  Councils  meet 
quarterly  to  aid  in  disseminating  information  about  Society  ac- 
tivities to  students  as  a whole  was  approved.  Space  will  be  made 
available  in  the  Illinois  Medical  Journal  for  this  purpose. 

Specialty  Representation  on  ISMS  Councils 

Procedure  has  been  established  enabling  specialty  societies 
to  be  directly  represented  on  ISMS  Councils.  Representatives 
nominated  by  the  specialty  society,  after  approval  by  the  ISMS 
Board  of  Trustees,  are  designated  consultant  members  of  the 
Council  to  which  appointed  (without  vote).  The  first  applica- 
tion of  this  procedure  has  resulted  in  the  appointment  of  Dr. 
S.  Dale  Loomis  as  consultant  to  the  Council  on  Mental  Health  and 
Addiction,  representing  the  interests  of  the  Illinois  Psychia- 
tric Society. 

Staff  Reorganization 

The  forthcoming  retirement  of  a senior  staff  member,  Mrs. 
Frances  Zimmer,  and  a desire  to  make  further  maximum  use  of 
existing  staff  capabilities  has  resulted  in  a reorganization 
plan  for  the  ISMS  staff.  Acting  on  recommendations  of  the  Execu- 
tive Committee,  the  Board  adopted  the  plan  suggested  by  the 
Executive  Administrator.  Under  the  plan,  Mr.  James  Slawny  will 
be  promoted  to  Assistant  Executive  Administrator  with  respon- 
sibility for  coordinating  the  Society's  various  ongoing  pro- 
grams. In  addition  to  Administration,  staff  divisions  will  be 


612 


Illinois  Medical  Journal 


maintained  as  follows:  Publications  and  Scientific  Services, 
Richard  Ott,  Director;  Legislation  and  Public  Affairs,  Timothy 
Selleck,  Director;  Economics,  Joseph  Lotharius,  Director;  Pub- 
lic Relations,  Bob  Westerbeck,  Director.  Mr.  Perry  Smithers  and 
his  staff  will  be  transferred  to  the  Administrative  Division 
with  Mr.  Smithers  named  Assistant  to  the  Executive  Administra- 
tor. He  will  retain  his  duties  as  Convention  Manager,  assume 
those  formerly  handled  by  Mrs.  Zimmer,  with  additional  duties  to 
be  assigned. 

Group  Immunization  and  Examination  of  School  Children 

An  error  in  reporting  actions  of  the  1970  House  of  Delegates 
as  published  in  the  Abstracts  of  the  House,  May  1970  was  noted. 
The  abstracts  contained  a notation  that  policy  was  adopted  which 
requires  that 

"the  ISMS  urge  all  school  districts  in  the  state  to  provide 
funds  in  the  budget  to  employ  sufficient  doctors  and  other 
health  professionals  to  carry  out  school  health  procedures 
as  required  by  law." 

Examination  of  the  official  transcript  of  proceedings  of  the 
House  of  Delegates  reveals  that  this  portion  of  the  report  of 
the  Committee  on  Child  Health  was  not  adopted  and  was  referred 
back  to  the  Board  of  Trustees  for  assignment  to  the  appropriate 
Council  for  further  study.  The  Board  acted  to  refer  this  matter 
to  the  Council  on  Environmental  and  Community  Health.  The  exist- 
ing policy  on  this  matter  as  contained  in  the  Policy  Manual  reads 
as  follows; 

"All  physical  examinations  should  be  performed  in  the  phy- 
sician's office.  No  examinations  should  be  conducted  on  a 
group  basis  unless  authorisation  has  been  given  by  the  local 
county  medical  society  in  a single  instance  or  for  a speci- 
fic purpose. 

This  general  statement  does  not  apply  to  the  industrial  or 
occupational  health  physician  in  his  in-patient  activi- 
ties." 

PRO  vs.  PSRO 

Attention  was  given  to  the  several  proposals  now  under  con- 
sideration by  the  Congress  in  the  field  of  peer  review.  Action 
on  these  programs  is  anticipated  in  conjunction  with  the  Social 
Security  Amendments  as  contained  in  HR  17550  which  has  passed 
the  House  of  Representatives  and  is  now  before  the  Senate  Finance 
Committee.  Section  227  of  the  Act,  as  passed  by  the  House,  would 
permit  the  Secretary  of  HEW  to  convene  panels  composed  of  physi- 
cians and  non-physicians  to  examine  utilization  charges,  etc. 
under  the  Medicare  and  Medicaid  programs.  To  offset  this  de- 
velopment, the  AMA  has  developed  a plan  for  the  formation  of 
a peer  review  organization  (PRO)  which  would  authorize  this  ac- 
tivity under  the  control  of  state  and  county  medical  societies 
utilizing  physicians  only  for  the  review  decisions.  The  Senate 
Finance  Committee  is  currently  considering  an  amendment  to  HR 
17550  submitted  by  Sen.  Wallace  Bennett  (R-Utah) , which  would 
provide  for  the  establishment  of  a Professional  Service  Review 
Organization  (PSRO)  which  goes  substantially  beyond  the  plan 
recommended  by  AMA  and  would  not  assure  complete  physician  con- 
trol. Final  action  on  HR  17550  and  the  Bennett  Amendment  has  been 
postponed  until  the  Congress  reconvenes  on  November  16.  Senate 
action  on  this  bill  will  be  subject  to  further  consideration  by 
a Conference  Committee  between  the  House  and  Senate  where  the 


for  December,  1970 


613 


difference  in  actions  by  the  two  Houses  will  be  reconciled. 

In  acting  upon  this  matter,  the  Board  endorsed  PRO  as  defined 
in  the  AMA  Medicredit  bill.  The  Board  took  further  action  to 
disapprove  any  extension  of  peer  review  as  proposed  in  the  Ben- 
nett Amendment  which  differs  from  the  AMA  position  at  the  present 
time. 

Legal  Decisions 

In  reversing  a decision  of  the  Lower  Court  in  the  case  of  Cun- 
ningham vs.  MacNeal  Memorial  Hospital,  the  Illinois  Supreme 
Court  has  classified  blood  transfusion  as  a product  not  a serv- 
ice. This  invokes  the  doctrine  of  implied  warranty  and  makes  the 
physician,  hospital  and  others  libel  for  hepatitis  contracted 
through  blood  transfusion.  Legal  counsel,  Frank  Pfeifer,  ad- 
vised the  Board  that  a consent  form  has  been  developed  as  a tem- 
porary measure  but  that  legislative  action  to  grant  immunity  is 
the  only  permanent  solution.  A discussion  of  this  issue  and  a 
copy  of  the  suggested  consent  form  appear  in  the  November  Illi- 
nois Medical  Journal.  Legislation  is  being  drafted  for  intro- 
duction in  the  next  General  Assembly  which  convenes  in  January. 
Governor  Ogilvie  has  offered  his  support  for  this  legislation. 

Legal  counsel  also  discussed  the  case  of  Lipsey  vs.  Michael 
Reese  Hospital  in  which  the  Supreme  Court  action  effectively 
eliminates  the  two-year  statute  of  limitation  on  liability  ac- 
tions. Modifications  in  the  application  of  the  discovery  rule 
would  allow  action  to  commence  within  two  years  after  date  of 
discovery  rather  than  two  years  after  the  incident.  This  case 
was  discussed  in  the  September  issue  of  the  Illinois  Medical 
Journal . 

Legal  counsel  further  discussed  the  so-called  "sick  doctor" 
statute  which  provides  for  revocation  of  license  for  a physician 
who  is  an  alcoholic,  drug  addict  or  mentally  incompetent.  The 
Board  acted  to  refer  this  matter  to  the  Council  on  Legislation 
and  Public  Affairs  for  further  study  in  consultation  with  the 
Committee  on  Licensure. 

Loan  Program  for  Inner  City  Students 

Based  upon  a mandate  from  the  House  of  Delegates  (Resolution 
70M-44)  and  recommendation  of  the  Task  Force  on  Physician  Short- 
age and  Services  to  Medically  Deprived  Areas,  the  Board  ap- 
proved meetings  with  representatives  of  the  city  of  Chicago, 
the  Joint  Negro  Appeal,  Sears  Foundation,  the  Woodlawn  Organi- 
zation and  the  Combined  Community  Organization.  The  meeting 
would  explore  the  potential  for  establishing  a loan  program  for 
medical  students  from  the  inner  city,  who  upon  completion  of 
training  would  return  to  practice  in  ghetto  areas.  Methods  of 
funding  such  a program  would  also  be  discussed. 

Liaison  with  Interns  and  Residents 

Acting  on  recommendation  of  the  Task  Force  on  Physician  Short- 
age and  Services  to  Medically  Deprived  Areas,  the  Board  ap- 
proved financial  and  staff  assistance  to  help  residents  and  in- 
terns located  in  Illinois  to  form  a statewide  organization. 
This  will  enhance  membership  possibilities,  co-sponsorship  of 
mutually  beneficial  programs  and  otherwise  provide  a means  of 
communication  with  this  group. 


614 


Illinois  Medical  Journal 


State  Bureau  of  Toxicology 

Several  concerns  were  manifest  in  the  report  of  the  Council 
on  Legislation  regarding  toxicology  services.  The  State  Bu- 
reau of  Toxicology  is  being  pressed  into  greater  service  with 
limited  staff.  A laboratory  authorized  for  Springfield  has  never 
been  established.  In  addition  there  is  a proposal  to  move  the 
Bureau  from  Public  Health  to  Law  Enforcement.  The  Board  endorsed 
the  concept  of  working  with  Dr.  Yoder,  Director  of  Public  Health, 
to  alleviate  the  problem  and  to  request  the  Governor  to  retain 
the  Bureau  under  the  Department  of  Public  Health.  A letter  to 
Dr.  Yoder  regarding  the  elimination  of  one  chemist  in  the  labora- 
tory was  also  authorized. 

Chiropractic  Concerns— The  Kentucky  Plan 

Recent  activity  by  chiropractors  in  petitioning  for  coverage 
under  Medicaid  was  cited.  The  Board  adopted  a recommendation 
to  approve  in  principle  the  so-called  "Kentucky  Bill"  which 
would  amend  the  Medical  Practice  Act  to  require  chiropractors 
(as  well  as  all  professionals  under  the  Act)  to  be  graduates  of 
schools  accredited  by  the  Office  of  Education,  U.  S.  Department 
of  Health  Education  and  Welfare  as  well  as  the  National  Commis- 
sion on  Accrediting.  Further  plans  on  this  proposal  will  be 
worked  out  by  the  Council  on  Legislation  and  Public  Affairs. 

DVR  Services 

The  Advisory  Committee  to  DVR  has  expressed  concern  over  the 
eligibility  standards  applied  under  the  Division  of  Vocational 
Rehabilitation  program.  The  Board  approved  a request  by  the 
Committee  for  the  development  of  a questionnaire  to  be  distrib- 
uted to  all  county  medical  societies  giving  opportunity  to  each 
for  expression  of  opinion  regarding  DVR  programs  in  Illinois. 

Physicians-On-Call 

The  operation  of  a firm  called  "Physicians-on-Call, " which 
contracts  to  provide  medical  coverage  for  hospital  emergency 
rooms  and  locum  tenens  for  physicians  was  discussed.  An  in-depth 
study  of  this  type  of  service  by  the  Council  on  Social  and  Medical 
Services  was  authorized. 

Licensure 

The  Committee  on  Licensure  reported  progress  in  its  study  of 
licensing  problems,  particularly  reciprocity  licensing  for  phy- 
sicians. An  early  meeting  with  the  physician  members  of  the  Medi- 
cal Examining  Committee  of  the  Department  of  Registration  and 
Education  is  scheduled.  In  acting  on  the  report,  the  Board  en- 
dorsed a recommendation  to  be  forwarded  to  the  Medical  Examin- 
ing Committee  as  follows; 

that  if  a physician  is  licensed  in  another  state  ; or,  has 
passed  a national  board  examination;  or,  is  certified  in 
his  specialty;  or,  is  recognized  as  board  eligible;  there 
should  be  a realistic  appraisal  in  granting  licensure  by 
reciprocity  or  endorsement  after  appropriate  investiga- 
tion. 

In  related  action,  the  Board  agreed  with  the  Council  on  Edu- 
cation and  Manpower  that  Legislation  should  be  developed  to 
amend  the  time  requirements  in  the  Medical  Practice  Act  to  ac- 
commodate students  admitted  to  medical  school  with  advance 
standing. 


jor  December,  1970 


615 


Annual  Meeting 


Preliminary  plans  for  the  1971  Annual  Meeting  were  reviewed. 
Great  enthusiasm  was  expressed  relative  to  the  facilities  at 
Arlington  Towers.  Self-testing  and  short  courses  will  be  new 
features  at  the  meeting.  The  general  format  will  be  as  follows; 
8;30-10;00  a.m. — Instructional  courses  (12  each  day) 

10:00-10:30  a.m. — Exhibit  break 

10:30-12:00  noon — Specialty  society  programs 
2:00-  4:00  p.m. — General  sessions 

In  other  actions,  the  Board— 

• Requested  the  Committee  on  Health  Care  Financing  to  explore 
with  Department  of  Mental  Health  Director,  Dr.  Albert  Glass, 
procedures  for  resolving  problems  occurring  in  the  Department's 
purchase  of  psychiatric  services  from  physicians. 

• Authorized  reprinting  and  updating  of  the  Society's  bro- 
chure describing  membership  services  and  distribution  of  a new- 
ly-developed new  member  packet. 

• Authorized  the  mailing  of  materials  to  all  physicians  in 
support  of  the  Water  Pollution  Bond  issue. 

• Authorized  the  Executive  Administrator  to  work  with  Dr. 
Albert  Snoke,  Governor's  Coordinator  for  Health,  in  the  latter's 
efforts  to  bring  various  agencies  together  for  a discussion  of 
problems  in  health  care. 

• In  connection  with  the  above,  authorized  the  Executive  Ad- 
ministrator to  develop  a listing  of  objectives  for  later  con- 
sideration by  the  Executive  Committee  and  Board  of  Trustees. 

• Awarded  the  printing  contract  for  the  Journal  to  Neely 
Printing,  and  the  contract  for  "Pulse"  to  Carl  Gorr  Printing. 

• Approved  development  of  a readership  survey  of  the  Illinois 
^di£a^  Journal . 

• Approved  the  initiation  of  legislation  to  require  physical 
exams  for  non-public  school  bus  drivers  and  greater  enforce- 
ment of  this  requirement  for  public  school  bus  drivers. 

• Granted  permission  for  the  Council  on  Economics  and  Peer 
Review  to  publicize  peer  review  information  in  the  IMJ. 

• Approved,  in  principle,  establishment  of  a statewide  Coun- 
cil for  Home  Health  Services. 

• Authorized  a one-day  workshop  in  1971  to  cover  "Improving 
Physician-Nurse  Communications,"  to  be  held  in  cooperation  with 
the  League  for  Nursing  and  the  Illinois  Nurses  Association. 

• Referred  to  the  Finance  Committee  a request  for  funds  to  sup- 
port student  attendance  at  1971  AMA  meetings  and  approved  at- 
tendance of  four  students  at  the  Boston  clinical  meeting  under 
present  budget  allocations. 

• Approved  in  principle  legislation  to  create  a "Critical 
Health  Problems  and  Comprehensive  Health  Education  Program"  in 
the  Department  of  Public  Instruction  and  referred  to  the  Legis- 
lative Council  for  further  consideration. 

• Acted  to  recommend  to  the  Illinois  Department  of  Children 
and  Family  Services,  development  of  a pilot  program  to  experi- 
ment with  less  frequent  examinations  required  for  children — 
currently  every  two  years. 

• Acted  to  recommend  to  Departments  of  Public  Instruction  and 
Public  Health  that  examinations  required  of  children  entering 
school  the  first  time,  and  at  fifth  and  ninth  grades  be  considered 
valid  if  performed  six  months  prior  to  entry  or  at  any  time  dur- 
ing the  year  following  such  entry. 


616 


Illinois  Medical  Journal 


o Authorized  the  Public  Relations  Division  to  develop  a pro- 
gram to  educate  and  influence  eighth  and  ninth  graders  regard- 
ing hazards  of  drug  abuse. 

• Approved  a recommendation  of  the  Child  Health  Committee 
calling  for  around-the-clock  availability  of  juvenile  justices 
in  all  parts  of  the  state  to  declare  children  wards  of  the  state 
whose  parents  are  unwilling  or  unable  to  give  consent  for  neces- 
sary medical  or  surgical  procedures  (current  procedure  in  Cook 
County). 

® Endorsed  a suggestion  from  the  Maternal  Welfare  Committee 
that  an  educational  program  based  on  maternal  death  studies  be 
considered  for  presentation  at  the  Annual  Meeting. 


Appointments  and  Authorizations 


Recommended  to  the  Governor,  for  appointment  on  the  Illinois 
Delegation  to  the  1971  White  House  Conference  on  Aging,  were: 
Dr.  Thomas  Tourlentes,  Galesburg;  Dr.  Bertram  Moss,  Chicago; 
Dr.  L.  T.  Fruin,  Normal;  and  support  was  given  to  the  nomination 
of  Mrs.  Ruth  Scrivner,  who  was  suggested  through  other  channels. 

The  following  ISMS  members  were  recommended  for  appointment 
to  the  Governor's  Committee  for  Senior  Citizens:  Dr.  Thomas 
Tourlentes,  Galesburg;  Dr.  W.  W.  Bowers,  Granite  City;  Dr.  J. 
R.  Durham,  Mendota  ; Dr.  Bertram  Moss,  Chicago;  Dr.  Clyde  Ruli- 
son,  Roberts;  Dr.  LeRoy  P.  Levitt,  Chicago;  Dr.  Jack  Weinberg, 
Chicago;  Dr.  Edward  W.  Cannady,  East  St.  Louis. 

Dr.  Eugene  Johnson,  Casey,  appointed  to  replace  Dr.  James 
Hartney  (at  his  request)  as  a member  of  the  Board  of  Directors 
of  the  Health  Careers  Council  of  Illinois. 

Dr.  Andrew  Brislen,  Chicago,  appointed  as  ISMS  representative 
to  the  Illinois  Council  on  Voluntary  Health  Agencies,  replacing 
Dr.  Charles  Vil,  Evergreen  Park. 


Surgical  Grand  Rounds 

(Coyitinued  from  pas,e  593) 


Dr.  Conn:  What  about  phlebitis? 

Dr.  Sherman:  We  use  a polyvinylchloride 
catheter.  We  have  not  seen  phlebitis  al- 
though we  have  had  clots  in  some  of  the 
catheters.  We  had  one  patient  who  de- 
velo])ed  a minimal  amount  of  pulmonary 
hypertension,  and  we  thought  this  might 
be  due  to  the  fact  that  small  microemboli 
were  being  thrown  from  the  catheter  into 
the  lungs  producing  pulmonary  hyperten- 
sion. 

Dr.  Conn:  Then  it  appears  that  some  of 
the  phlebitis  that  we  have  seen  after  intra- 
venous therapy  and  have  been  blaming  on 
various  things  is  probably  due  to  contami- 
nation and  bacteria. 

Dr.  Sherman:  Let  me  just  say  that  the 
catheter  does  pass  through  the  external 
jugular  vein.  To  minimize  the  chances  of 
contamination  we  change  the  dressing  every 
three  days.  We  defat  the  skin  with  ether 
and  then  paint  the  skin  with  iodine  solu- 
tion and  apply  a small  amount  of  Neo- 
sporin  ointment.  Some  of  our  patients  have 


had  the  same  catheter  for  two  months  with- 
out evidence  of  phlebitis. 

Dr.  Conn:  This  would  speak  then  for  a 
little  more  care  in  placing  intravenouses 
and  a little  more  attention  to  taking  care 
of  them. 

Dr.  Gabriel  Lorenzo : Do  you  have  a prob- 
lem with  diuresis  and  how  do  you  avoid 
that? 

Dr.  Sherman:  The  solution  we  use  has 
an  osmolarity  of  over  1400  milliosmoles  per 
liter.  This  high  osmolarity  results  from  the 
high  concentration  of  glucose  in  the  solu- 
tion. Years  ago.  Dr.  Francis  Moore  suggest- 
ed that  an  insulin  “chaser”  be  given  after 
infusing  concentrated  glucose  solutions.  Dr. 
Stanley  Dudrick,  tbe  originator  of  paren- 
teral hyperalimentation,  noted  that  if  the 
glucose  infusion  is  limited  to  1.2  gm.  per 
kilogram  of  weight  per  hour,  the  glycosuria 
is  limited.  We  see  an  osmotic  diuresis  for 
about  two  days  with  glycosuria  and  hyper- 
glycemia. After  two  to  three  days,  the  urine 
is  negative  for  sugar  and  the  blood  sugar 
averages  between  70  and  90  mgm.%.  ◄ 


for  December,  19/0 


617 


Hyperkineticism  in  children 


About  four  out  of  every  100  grade-school 
children  in  the  U.S.  are  hyperkinetic— the 
victims  of  excessive  and  uncontrolled  mo- 
tion. 

Hyperkinesis  may  prevent  a child  from 
keeping  up  with  his  studies,  and  many 
children  referred  to  mental  health  clinics 
are  hyperkinetic. 

Controlled  dosage  with  Ritalin  (methyl- 
phenidate  hydrochloride),  a central  nervous 
system  stimulant,  has  proved  the  best  of 
several  drugs  prescribed  for  such  children. 
Dr.  J.  Gordon  Millichap,  a Northwestern 
University  neurologist,  reports. 

The  hyperkinetic  child  is  restless,  impul- 
sive, and  garrulous  and  has  a short  atten- 
tion span,  said  Dr.  Millichap,  professor  of 
neurology  and  pediatrics  and  director  of 
neurology  at  The  Children’s  Memorial 
Hospital,  Chicago. 

The  child’s  actions  are  irrelevant  and 
without  clear  direction,  focus,  or  object, 
but  intelligence,  achievement,  and  other 
special  tests  are  necessary  to  identify  hyper- 
kinesis as  the  principal  cause  of  the  child’s 
learning  disorder,  writes  Dr.  Millichap. 

“The  hyperkinetic  child  may  be  mentally 
retarded,  but  he  is  often  of  average  or 
above-average  intelligence  but  below  nor- 
mal in  schoolwork  performance.” 

Dr.  Millichap  has  studied  the  use  of 
drugs  in  treating  hyperactive  children  for 
the  past  five  years.  His  research  has  been 
supported  by  grants  from  the  National  In- 
stitute of  Neurological  Diseases  and  Blind- 
ness, the  Brain  Research  Foundation,  the 
W.  Clement  and  Jessie  V.  Stone  Founda- 
tion, and  the  Dreyfus  Medical  Foundation. 

Here  is  what  he  found: 

—Reporting  on  his  own  experience  at 
The  Children’s  Memorial  Hospital,  Dr. 
Millichap  said  that  the  best  results  were 
obtained  with  Ritalin.  A review  of  medical 
literature,  including  his  own  reports,  shows 
that  of  337  patients  who  received  Ritalin 
(methylphenidate),  84%  were  benefitted. 

—of  415  patients  treated  with  ampheta- 
mine (Dexedrine),  another  stimulant,  69% 
showed  improvement  in  behavior.  The 
stimulant  deanol  acetamidobenzoate  (Dea- 


ner)  was  less  effective,  producing  improved 
behavior  in  47%  of  a total  of  239  patients 
treated  by  various  investigators,  and  failing 
to  produce  any  beneficial  effects  at  all  in 
three  controlled  studies. 

— Chlordiazepoxide  (Librium)  and  chlor- 
promazine  (Thorazine)  controlled  hyper- 
kinetic behavior  in  60%  of  the  cases  treated 
by  some  workers  in  the  field,  and  reserpine 
(Raurine,  Reserpoid,  Serpasil)  was  effec- 
tive with  34%. 

Dr.  Millichap  and  his  associates  recently 
reported  on  a preliminary  study  of  anti- 
convulsant drugs  at  The  Children’s  Me- 
morial Hospital  prescribed  for  children 
whose  learning  problems  were  complicated 
by  abnormalities  in  the  electroencephalo- 
gram. They  found  that  diphenylhydantoin 
sodium  (Dilantin  sodium)  caused  a signi- 
ficant improvement  in  a test  of  auditory 
perception  involving  attention,  memory, 
and  recall. 

Phenobarbital,  however,  was  found  to 
“have  variable  effects  and  often  exacerbates 
the  hyperactivity,”  Dr.  Millichap  reported. 

Dr.  Millichap  recommends  starting  the 
patients  on  the  drugs  at  certain  levels  and 
stepping  up  the  dosage  over  several  weeks, 
observing  effects  by  repeating  a battery  of 
neuropsychological  tests. 

“A  relapse  in  behavior  and  deterioration 
in  school  grades  following  drug  withdrawal 
are  an  indication  for  repeated  short-term 
trials,”  he  counsels.  “Long-term  treatment 
can  be  prescribed,  provided  that  testing  is 
repeated  at  regular  intervals  in  order  to 
determine  the  effectiveness  of  the  drugs.” 

An  actomoter,  an  automatically  winding 
calendar  wristwatch  with  the  pendulum 
attached  directly  to  the  hands  of  the  watch, 
is  the  most  useful  available  mechanical  de- 
vice in  evaluating  the  effect  of  drugs  on 
hyperactive  children.  Dr.  Millichap  says. 

The  pendulum  rotates  in  a plane  parallel 
to  the  face  of  the  watch,  and  movements 
with  a component  at  right  angles  to  this 
plane  are  recorded.  The  instrument  is  worn 
on  the  wrist  or  ankle  and  provides  conven- 
ient daily  readings,  indicating  excessive 
movement. 


The  well  can  run  dry 

“When  the  masses  of  the  people  find  they  con  vote  themselves  prosperity 
from  the  public  treasury,  a democracy  is  no  longer  possible."— Socrates. 


(iI8 


Illinois  Medical  Journal 


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for  December,  1970 


619 


ILLINOIS 

MEDICAL 

ASSISTANTS 

ASSOCIATION 


REPORT 


“To  be  or  not  to  be . . . 

By  Thelma  Peplow/Sycamore 


The  words  in  the  title  are  very  short;  the 
longest  word  has  three  letters,  the  word 
“not.”  Many  will  recall  these  famous  words 
of  the  great  Shakespeare  from  the  equally 
famous  play  of  Hamlet.  The  quote  of  these 
six  small  words  is  recognizable  to  many  an 
ear,  even  though  they  do  not  know  where 
it  came  from.  “To  be  or  not  to  be”  is  an 
expression  used  by  others,  just  to  be  using 
words. 

What  should  these  words  mean  to  the 
Medical  Assistant  and  to  the  members  of 
the  Medical  Assistants  Association?  Let  us 
analyze  the  first  words,  TO  BE.  TO  BE, 
means  many  things  to  the  Medical  Assistant 
—remember,  our  association  helps  to  edu- 
cate the  Medical  Assistant.  TO  BE,  does 
not  and  should  not  command  an  authori- 
tative outward  demand  on  others.  TO  BE 
for  the  Medical  Assistant  means  for  the 
good  of  herself,  TO  BE  able  to  listen,  to 
listen  attentively,  to  develop  remembrance, 
above  all,  the  concentration  of  her  tongue, 
being  careful  to  answer  questions  and  re- 
marks intelligently  so  as  not  to  anger  her 
audience.  Her  audience  can  be  many  or 
only  one  person. 

TO  BE,  to  some  is  a way  of  overcoming 
an  inferior  complex.  Many  Assistants  who 
were  timid,  shy,  unable  to  meet  people  in 
a comfortable  manner  have  been  helped 
through  the  educational  programs  the  Med- 
ical Assistants  Association  provides.  The 
Assistant  becomes  interested,  becomes  in- 
volved in  discussions,  and  becomes  a part 


of  the  Association.  All  the  time  she  is  teach- 
ing herself,  overcoming  the  obstacles  that 
are  handicapping  her. 

TO  BE  able  to  help,  guide,  show  kind- 
ness, compassion  to  everyone  on  an  equal 
basis,  wealthy  or  poor,  makes  for  a better, 
stronger  character;  a more  humble  and  ap- 
preciative Medical  Assistant.  There  are  so 
many  “TO  BE’s,”  just  thinking  about  them 
can  expand  in  developing  the  character  of 
the  Medical  Assistant  if  she  so  desires  it. 

NOT  TO  BE,  the  longest  word  “not”  is 
an  obtuse  word  to  the  Medical  Assistant. 
NOT  TO  BE  can  be  used  in  ways  not  be- 
coming to  the  Medical  Assistant.  NOT  TO 
BE  a part  of  an  Association,  NOT  wanting 
to  learn,  NOT  wanting  to  see,  NOT  want- 
ing to  hear  or  participate  with  other  mem- 
bers whose  work  is  similar  to  hers,  NOT 
TO  BE  able  to  find  friendships  and  ex- 
changing of  ideas  through  educational  lec- 
tures and  hlms  are  only  a few  of  the  “NOT 
TO  BE’s”  to  the  Medical  Assistant. 

The  mind  needs  to  learn,  to  grow,  to 
expand  at  all  times.  The  NOT  TO  BE, 
must  be  left  behind.  The  TO  BE  must  be 
pressed  forward. 

Which  is  your  assistant  doctor,  the  “TO 
BE”  or  the  “NOT  TO  BE?” 

For  information  regarding  membership 
in  this  organization  please  contact  Mrs. 
Norma  Domanic,  150  Ash  Street,  New  Len- 
nox, 111.  60451  or  Mrs.  Vivian  Kraft,  R.R. 
No.  2,  Normal,  111.  61761. 


620 


Illinois  Medical  Journal 


Meeting  Memos 

Jan.  2-21 — American  College  of  Sur- 
geons 

Scientific  Winter  Cruise,  Sectional  meetings 
55  East  Erie  St.,  Chicago 

Jan.  7-9 — American  Cancer  Society 

National  Conference  on  Cancer  of  the  Colon  and 
Rectum 

Hotel  del  Coronado,  San  Diego,  Calif. 

Jan.  8 — The  Chicago  Heart  Association 

lames  B.  Herrick  Memorial  Lecture 

■'The  Natural  History  of  Hypertension  and  Effect 

of  Treatment'’ 

Sheraton-Blackstone  Hotel,  Chicago 

Jan.  13-14 — Clevelaml  Clinic  Education- 
al Foundation 

Postgraduate  course  program 
“Fifty  Years  of  Surgical  Progress" 

2020  East  93rd  St.,  Cleveland,  Ohio 

Jan.  22-24 — Arizona  Heart  Association 

t-llh  Annual  Cardiac  Symposium 
Arizona  Riltmoie  Hotel,  Phoenix,  iVri/ona 

Jan.  27-29 — PassavanI  Memorial  Hos- 
pital 

Memorial  Hospital 

“The  Year  in  Internal  Medicine" 

Offield  .\tiditorium,  Passavant  Memorial  Hospital, 
Chicago 


Obituaries 

*Jennie  K.  Amtnian,  Chicago,  died  Oc- 
tober 11  at  the  age  ol  h8. 

*Dauiel  Haffron,  Elgin,  dietl  in  October 
at  the  age  ol  64.  He  was  lornier  snjterin- 
tendent  ol  titc  Elgin  State  Hospital. 
*David  M.  Jenkins,  Bloomington,  died 
September  13  at  the  age  ol  67.  He  was  lor- 
nier jjresident  ol  the  Illinois  Obstetrical  and 
Gynecological  Society  and  past-prcsidetit  ol 
the  McLean  County  Medical  Society. 

*F.  J.  Maciejewski,  LaSalle,  died  at  the 
age  ol  86  on  October  8.  He  tvas  a member 
ol  the  ISMS  Eilty-Year  Club  and  past-presi- 
dent and  jiast-secretary  ol  the  l.aSalle 
County  Medical  Society. 

^William  A.  McNichols,  Sr.,  Dixon,  died 
Aitgust  28  ;it  the  age  ol  73.  He  was  past- 
president  and  past-secretary  ol  the  Lee 
County  Medical  Society  and  a member  ol 
the  ISMS  Eilty-Year  Club. 

"R.  Albert  Rutz,  Olympia  Eields,  died  Oc- 
tober 13  at  the  age  ol  80.  He  was  a mem- 
ber ol  the  ISMS  Eilty-Year  Club. 

^Indicates  member  of  Illinois  State  Medical  Society 


• • 


Z^aifuiew 

^J^o6pitai 

Dedicated  to  Progressive  Psychiatry 
and  Oriented  to  Short  Term 
Hospitalization  and  Treatment 


"MAN  IS  NOT  SOUL  OR  BODY,  BUT  THESE 
TWO  SUBSTANCES  INMOSTLY  UNITED" 


Psychological  and  Physiological  ther- 
apies for  the  neuroses,  psychoses  and 
psychosomatic  disorders,  with  special 
emphasis  on  INSULIN  DEEP  COMA 
THERAPY  for  the  schizophrenias  and 
the  newly  developed  INDOKLON 
THERAPY  for  the  depressions. 

FOR  ADOLESCENTS:  Quality  care  with 
specialized  programs  including  ac- 
credited schooling. 

Phone:  312-878-9700 
4840  NORTH  MARINE  DRIVE 
CHICAGO,  ILLINOIS  60640 

J.  Dennis  Freund,  M.D.,  Medical  Director 


for  December,  1970 


621 


when  irritable  colon  feels  like  this 


The  blowfish,  a small  species 
of  fish,  reacts  to  stress  or 
fright  by  puffing  itself  up  with 
air.  After  about  a dozen 
noisygulps  the  belly  is  balloon- 
shaped and  hard.  When 
replaced  in  the  water  the  air  is 
quickly  expelled,  and 
the  fish  sinks  to  the  bottom 


SOCIO 


ECONOMIC 

news 


A service  of  the  Public  Relations  and  Economics  Division 


By  Joseph  J.  Lotharius 


THE  AMERICAN  HOSPITAL  ASSOCIATION  DIFFERS  WITH  AMA  ON  "WHAT  IS  UTILIZATION 

REVISW."  The  difference  was  highlighted  in  a letter  from 
Dr.  Thomas  H.  Ainsworth,  Jr.,  AHA  associate  director  to 
medical  staff  presidents  and  medical  chiefs  to  member  hos- 
jjitals.  Dr.  Ainsworth’s  comments  were:  ‘‘The  hospital  medi- 
cal staff  concept  of  utilization  review  is  based  on  the  prem- 
ise that  the  hospital  is  not  just  a facility,  but  is  an  organi- 
zation of  physicians,  other  health  professionals,  and  institu- 
tions coojterating  in  the  delivery  of  health  care  services 
to  the  patient  at  the  community  level.  Its  goal  is  optimal 
utilization,  not  over-utilization  nor  under-utilization.  Thus, 
it  cannot  be  separated  from  a complete  medical  audit  of 
the  care  the  patient  receives,  which  is  a medical  staff  func- 
tion by  peer  review.” 

Di.  Ainsworth  goes  on  to  say,  ‘‘the  prime  concern  of  all 
hospitals  is  the  patient:  what  is  good  for  the  patient  is 
good  for  the  trustee,  the  administrator  and  the  medical 
staff— the  team  concept.  Thus,  utilization  review  becomes 
a management  tool  for  evaluating  policy  as  it  affects  pa- 
tient care.  While  this  type  of  review  is  a medical  staff 
function— fl  review  by  peers—it  is  also  a management  func- 
tion, . . .” 

‘‘This  type  of  review  is  not  disjointed,”  adds  Dr.  Ains- 
worth. ‘‘It  reviews  admission  to  the  hospital,  it  is  tied  to 
discharge  planning  from  the  day  of  admission,  it  reviews 
utilization  by  diagnosis  and  age  (standards),  and  in  many 
instances  serves  as  a prospective  review  before  transfer  to 
extended  care  institutions  or  home  care  programs.” 


INCREASES  IN  FEE  PAYMENTS  TO  PHYSICIANS  ARE  BEING  PLANNED  BY  DVR 

A fee  payment  adjustnrent  designed  to  meet  the  ‘‘usual 
charges  of  physicians  in  the  upper  two  quartiles”  is  being 
proposed  by  the  Illinois  Division  of  Vocational  Rehabilita- 
tion. DVR  Director,  Alfred  Sheer  said  the  new  fee  plan 
will  become  effective  January  1,  1971,  pending  approval 
by  the  Bureau  of  the  Budget.  Mr.  Sheer’s  announcement 
comes  in  response  to  an  ISMS  request  that  DVR  start  pay- 
ing usual  and  customary  fees.  Mr.  Sheer  claims  DVR  has 


for  December,  1970 


627 


been  paying  the  “average  usual  fee  of  the  most  common 
procedures  at  the  1969  level.” 

Under  the  new  proposal,  the  usual  and  customary  fee 
range  will  reach  charges  of  the  “additional  20%  of  physi- 
cians in  those  geographic  areas  where  usual  charges  are 
above  the  average  level.”  When  Mr.  Sheer  defines  these 
areas,  the  information  will  be  passed  on  to  ISMS  members. 

EACH  COUNTY  MEDICAL  SOCIETY  WILL  HAVE  A CHANCE  TO  EXPRESS  ITS  OPINIONS 

ABOUT  DVR  in  Illinois  on  a questionnaire  that  has  been 
sent  to  all  county  society  secretaries.  The  questionnaire, 
which  should  be  answered  by  the  county  society  at  its  next 
regular  meeting,  requests  physicians  to  list  specific  problems 
with  DVR  for  apparent  abuses  of  the  program.  County  so- 
cieties can  also  state  their  feelings  on  the  adequacy  of  pres- 
ent DVR  eligibility  guidelines.  The  purpose  of  the  ques- 
tionnaire is  to  gather  pertinent  information  for  the  Illinois 
Bureau  of  the  Budget  which  is  currently  studying  the  DVR 
program.  The  ISMS  Advisory  Committee  to  DVR  asks  each 
county  society’s  cooperation  in  completing  and  returning 
the  questionnaires  as  soon  as  possible. 

AMERICA'S  NO.  1 DOCTOR  IN  THE  NIXON  ADMINISTRATION  MAY  SOON  BE  LEAVING 

HIS  JOB  according  to  growing  rumors  (reported  in  WasJi- 
ington  Report  on  Medicine  & Health)  which  are  being 
“vigorously  denied”  in  Washington.  Dr.  Roger  O.  Egeberg, 
assistant  secretary  of  HEW,  “has  been  showing  the  strains 
of  the  demanding  job  and  newly  appointed  HEW  Secre- 
tary Elliot  Richardson  has  indicated  that,  in  good  time,  he 
would  like  his  own  man.”  Dr.  Egeberg,  who  recently  ap- 
peared as  keynote  speaker  for  the  ISMS  Leadership  Con- 
ference, turned  67  in  November.  HEW  insiders  say  that 
although  Dr.  Egeberg  doesn’t  look  like  a long-term  bet  to 
stay  on  the  job,  nothing  is  imminent. 

REPORTS  TO  ISMS  ARE  INCREASING  THAT  THE  ILLINOIS  DEPARTMENT  OF  PUBLIC  AID 

IS  NOT  paying  usual  and  customary  fees  to  physicians. 
Such  reports  have  just  been  received  from  Champaign  and 
Vermilion  counties  and  follow  closely  on  the  heels  of 
similar  complaints  from  many  other  counties  in  Southern 
Illinois.  IDPA  claims  it  pays  usual  and  customary  fees 
of  physicians  iqr  to  the  70th  percentile.  This  means  that— 
of  the  approximately  7,000  Illinois  physicians  treating 
IDPA  recipients— 70  per  cent  of  them  supposedly  are  paid 
their  usual  and  customary  lees.  IDPA  claims  it  reduces 
the  fees  of  the  physicians  in  the  upper  30th  percentile.  Ac- 
cording to  complaints,  however,  this  figure  seems  high. 

A growing  number  of  complaints  also  accuse  IDPA  of 
inconsistencies  in  claims  payments  (claims  paid  vary  for 
the  same  procedure  in  the  same  area  and  from  the  same 
physician). 

(Continued  on  page  639) 


628 


Illinois  Medical  Journal 


The  gas/acid  group  of  disorders 

“The  two  most  common  complaints  referable  to  the  upper 
gastrointestinal  tract  for  which  patients  seek  medical  relief  are 
hyperacidity  and  ‘gas.’  The  two  often  occur  together.”* 

Frees  captured  gas... neutralizes  free  acid 

Silain-Gel  Tablets  and  Liquid  are  separate  formulas  designed  to  provide 
equivalent  dual-action  symptomatic  relief.  Both  dosage  forms  contain 
simethicone  which  effectively  frees  trapped  gas,  enabling  the  patient  to 
eliminate  it.  Magnesium  hydroxide  in  both  assures  a rapid  rise  in 
pH  for  prompt  relief  of  hyperacidity.  The  special  co-dried  aluminum 
hydroxide/magnesium  carbonate  gel  in  the  tablets  assures  the 
same  rapid  and  uniform  reaction  rate  as  the  liquid.  Thus,  both  medications 
achieve  prompt  and  prolonged  neutralization  of  free  acid  plus  prompt 
relief  from  the  pain  and  pressure  of  trapped  gas. 

Always  in  good  taste 

The  pleasant,  distinctive  flavor  of  Silain-Gel,  as  well  as  its 
non-constipating  feature,  make  it  a therapy  your  patients  can  live  with- 
in comfort  and  without  complaint. 

Select  the  form  of  Silain-Gel  you  want  to  provide  symptomatic  relief  in: 
gastric  ulcer  • duodenal  ulcer  • heartburn  • gastric  hyperacidity  • 
gastritis  • dyspepsia 

when  the  patient  prefers  the  convenience  of  a tablet^  select 

Silain-Gel®  Tablets: 

when  the  patient  prefers  a liquid,  select 

Silain-Gel®  Liquid 

Also  available  for  the  patient  who  needs  an  antifrothicant/antiflatulent 
agent  only;  Silain®  (simethicone)  Tablets 

*Slanger,  A.:  Med.  Times 150  (Feb.)  1966. 


Announcing  the^Antgasid’’ 

Silain-Gef 

Tablets:  simethicone  plus  aluminum  hydroxiHe/magnesium  carbonate  co-dried  gel  and  magnesium  hydroxide 
Liquid:  simethicone  plus  aluminum  hydroxide  and  magnesium  hydroxide 

one  dose  does  both:  frees  captured  gas ...  neutralizes  free  acid 


A.H.  Robins  Company,  Richmond,  Virginia  23220 


Dicarbosil 

ANTACID 


Your  ulcer  patients  and 
others  will  confirm  it.  Specify 
DICARBOSIL  144's-144tab- 
lets  in  1 2 rolls. 


ARCH  LABORATORIES 

319  South  Fourth  Street.  St.  Louis,  Missouri  63102 


COOK  COUNTY 
Graduate  School  of  Medicine 
CONTINUING  EDUCATION  COURSES 

STARTING  DATES— 1970-1971 

SPECIALTY  REVIEW  COURSE  IN  ORTHOPEDICS,  Dec.  7 
SPECIALTY  REVIEW  COURSE  FOR  FAMILY  PRACTICE,  Feb.  1 
SPECIALTY  REVIEW  COURSE  IN  MEDICINE,  Part  II,  Feb.  1 
SPECIALTY  REVIEW  COURSE  IN  SURGERY,  Part  II,  Feb.  15 
SPECIALTY  REVIEW  COURSE  IN  THORACIC  SURGERY,  March 
29 

SPECIALTY  REVIEW  COURSE  IN  PEDIATRICS,  April  19 
PROCTOSCOPY  & VARICOSE  VEINS,  One  Week,  December  14 
SYMPOSIUM  ON  SHOCK,  Two  Days,  December  18 
VAGINAL  APPROACH  TO  PELVIC  SURGERY,  One  Week,  Dec.  14 
BASIC  ELECTROCARDIOGRAPHY,  One  Week,  March  8 
BASIC  INTERNAL  MEDICINE,  One  Week,  March  29 
CLINICAL  NEUROLOGY,  One  Week,  December  7 
DIAGNOSTIC  RADIOLOGY,  One  Week,  March  22 
RADIOISOTOPES,  One  or  Two  Weeks,  Request  Dates 
INHALATION  & REGIONAL  ANESTHESIA,  Request  Dates 
INFORMAL  CLINICAL  COURSES  IN  SUBSPECIALTIES,  Request 
Dates 

Information  concerning  numerous  other 
continuation  courses  available  upon  request, 

TEACHING  FACULTY 

Attending  Staff  of 
Cook  County  Hospital 

Address: 

REGISTRAR,  707  South  Wood  Street, 
Chicago,  Illinois  60612 


Hemodialysis 

(Continued  from  page  597) 

cal  advances  will  continue  and  that  by  the 
end  of  the  20th  century,  the  kidney  ma- 
chines of  our  age  will  be  as  obsolete  as  the 
Model-T  Ford.  ◄ 


References 

1.  Reddy,  C.  R.,  Gara,  A.  H.,  Bergman,  L.  A., 
Ellison,  M.  R.,  Smith,  C.  R.  & Dunea,  G.,  “Ex- 
perience with  a new  hemodialyzer.  The  EX-03 
Dialyzer  cartridge,”  Chgo.  Med.  Sch.  Quart., 
Eall,  1970. 

2.  Bergman,  L.  A.,  Basha,  N.  M.,  Gara,  A.  H., 
Ellison,  M.  R.,  Smith,  E.  G.  and  Dunea,  G., 
“The  EX-01  Dialyzer  cartridge.  Experience  with 
800  dialyses,”  Trans.  Amer.  Soc.  Artif.  Int.  Org., 
15:65-67,  1969. 

3.  Bell,  R.  P.  and  Figeroa,  T.  E.,  “Hemodialysis 
cost  reduction  by  artificial  kidney  storage:  a 
simple,  effective  technique  for  re-use  of  coil 
kidneys,”  Brit.  Med.  ].,  1:788-789,  1970. 

4.  Versaci,  A.  A.,  Soriano,  R.  V.,  and  Dunea,  G., 
“Washing  machine  dialysis  with  a new  Twin 
Coil  kidney,”  I.M.].,  134:693-695,  1968. 

5.  Pendras,  J.  P.  and  Pollard,  T.  L.,  “Eight  years 
experience  with  a community  dialysis  center. 
The  Northwest  Kidney  Center.”  Trans.  Amer. 
Soc.  Artif.  Int.  Org.,  16:77-84,  1970. 

6.  Brescia,  J.  J.,  Cimeno,  J.  E.,  Appel,  K.  and 
Hurwich,  B.  J.,  “Chronic  hemodialysis  using 
venepuncture  and  a surgically  created  arterio- 
venous fistula,”  New  Eng.  J.  Med.,  275,  1089- 
1092,  1966. 

7.  Kaye,  M.,  Chatterjee,  G.,  Cohen,  G.  F.  and 
Sagar,  S.,  “Arrest  of  hyperthyroid  bone  disease 
with  dihydrotachysterol  in  patients  undergo- 
ing chronic  hemodialysis,”  Ann.  Int.  Med.,  73, 
225-233,  1970. 

Acknowledgment 

I wish  to  thank  Mrs.  Ruth  Schreiner  and 
Dr.  R.  F.  Sondag,  M.D.,  M.P.H.  for  their 
help  in  tlie  preparation  of  this  paper. 


...  to  set 

May  16-19  aside  for  the  annual 
ISMS  convention. 


632 


Illinois  Medical  Journal 


ESSENTIALS  OF 

OPHTHALMOLOGY 


ROLAND  I.  PRITIKIN 


EDITOR’S  NOTE 

The  purpose  of  tliis  printing  is  to  make  available  a 
book  that  serves  a worthwhile  purpose.  Part  of  that 
purpose  is  to  point  up  the  changes  that  have  occurred 
during  the  past  two  decades,  allowing  comparison  with 
the  old. 

It  is  fitting  that  such  a book  should  be  authored  by 
Roland  I.  Pritikin,  M.D.  A member  of  more  societies 
than  we  could  list  on  this  page,  this  man  has  helped  in 
staffing  missionary  hospitals  and  teaching  students  of 
ophthalmic  surgery  around  the  world.  Yet  the  most 
significant  achievements  were  those  of  everyday  practice 
in  which  he  has  spent  these  last  two  decades,  sharing  in 
and  contributing  to  the  changes  that  have  made  a great 
specialty  much  greater. 

Dr.  Pritikin  has  honored  me  by  asking  for  my 
editorial  comments. 

Eugene  V.  Grace,  M.  D. 


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JS 


for  December,  1970 


633 


Index  To  Volume  138 


July  through  December,  1970 


Page  1-  96  July 

97-182  August 
183-284  September 
285-470  October 
471-564  November 
565-642  December 


A 

ABSTRACTS  OF  BOARD  ACTIONS  19;  207  ; 577 
“Acoustic  neuroma”  (SURGICAL  GRAND 
ROUNDS)  (Beal,  ed)  509 
Actions  on  Resolutions.  See  CONVENTION 
SUMMARY. 

Almassy,  Arpad,  “Evaluation  of  Hypnotic  Effect 
of  Methaqualone  Employing  Placebo  Responder 
Elimination”  73 

AMPULLA  OF  VATER,  Argentaffine  carcinoma 
(carcinoid  tumor)  involving  the  (Stefanini, 
Urbas  and  Crockett)  130 
“An  analysis  of  500  consecutive  cases  of  acute 
appendicitis  in  a metropolitan  charity  hospital” 
(Sethi,  Matsuda,  Pemberton  and  Strohl)  147 
ANALYSIS  of  500  consecutive  cases  of  acute 
appendicitis  in  a metropolitan  charity  hospital, 
An  (Sethi,  Matsuda,  Pemberton  and  Strohl) 
147 

ANATOMY,  Illinois’  anatomical  gift  act  (SPE- 
CIAL ARTICLE)  (Pfeifer)  154 
ANEURYSM,  popliteal:  An  unresolved  problem 
(Powers  and  Sejdinaj)  33 
APPENDICITIS  in  a metropolitan  charity  hos- 
pital, An  analysis  of  500  consecutive  cases  of 
acute  (Sethi,  Matsuda,  Pemberton  and  Strohl) 
147 

APPROVED  SCHOOLS  (Reference  Issue)  394 
“Argentaffine  carcinoma  (carcinoid  tumor)  in- 
volving the  ampulla  of  Vater”  (Stefanini,  Ur- 
bas and  Crockett)  130 

“Arteriography:  principles  and  techniques”  (Sa- 
vory) 215 

ASTHMA  occur  at  night.  Why  does?  (Unger)  123 
AUXILIARY  Woman’s  to  ISMS  (Reference  Is- 
sue) 391 


B 

Beal,  J.  M.,  ed.,  (SURGICAL  GRAND  ROUNDS) 
37;  125;  229;  509;  589 

Bellows,  John  G.,  “Contemporary  Practices  in 
Ophthalmology”  (MEDICAL  PROGRESS)  47 
BLUE  SHIELD  REPORT  1;  97;  183;  285;  471;  565 


Blythe,  June  “Educating  the  total  health  team” 
(SPECIAL  ARTICLE)  170 

BOARD  ACTIONS,  Abstracts  of  19;  207;  577 

BOOK  REVIEWS 

Benton  (ed.),  Contributions  to  Clinical  Neuro- 
psychology, 152 

Botsford,  Thomas,  W.,  M.D.  and  Wilson,  Rich- 
ard E.,  M.D.  The  Acute  Abdomen,  526 
Burford  and  Ferguson  (eds.).  Cardiovascular 
Surgery,  Current  Practice,  152 
Cavanagh,  Denis  and  Talisman,  M.  R.,  Prema- 
turity and  the  Obstetrician,  84 
Clark,  Vivian  Vreeland  (ed.).  Outpatient  Serv- 
ices Journal  Articles,  608 
Cooper  (ed.).  Surgery  Annual  (Volume  1),  250 
Davidsohn,  Israel  and  Henry,  John  Bernard 
(eds.),  Todd-Sanford  Clinical  Diagnosis  By 
Laboratory  Methods,  84 
Fishman  and  Hecht,  'The  Pulmonary  Circula- 
tion and  Interstitial  Space,  152 
Gelperin,  Abraham,  and  Gelperin,  Eve  Arlin 
(eds.).  Emergency  Room  Journal  Articles,  608 
Hinshaw,  Diseases  of  the  Chest  (3rd  Edition), 
250 

Kosakai,  Nozomu  (ed.).  Illustrated  Laboratory 
Techniques,  608 

Pinkus  and  Mehregan,  A Guide  to  Dermato- 
histopathology,  250 

Starzl,  Thomas  E.,  Experience  in  Hepatic 
Transplantation,  455 

Watson,  William  L.  (ed.).  Lung  Cancer:  A 
Study  of  Five  Thousand  Memorial  Hospital 
Cases,  84 

Williams,  J.  Alexander  and  Cox,  Alan  G.  (eds.). 
After  Vagotomy,  608 

Boshes,  Louis  D.  and  Kienast,  Hans  W.,  “Com- 
munity aspects  of  epilepsy”  (MEDICAL 
PROGRESS)  140 

Breed,  J.  Ernest,  “The  plans  of  our  doctors  in 
training”  (SPECIAL  ARTICLE)  536;  602 

Breed,  J.  Ernest  (THE  PRESIDENT’S  PAGE) 
11;  116;  194;  297;  494;  573 

Breinig,  Jessie,  “What  every  doctor  should  know” 
(ILLINOIS  MEDICAL  ASSISTANTS  ASSO- 
CIA'nON)  540 

Burke,  George  H.,  “Medical  Licensure:  Let’s  re- 
ciprocate” (SPECIAL  ARTICLE)  240 


634 


Illinois  Medical  Journal 


c 


F 


CARCINOMA  (carcinoid  tumor)  involving  the 
ampulla  of  Vater,  Argentaffine  (Stefanini,  Ur- 
bas  and  Crockett)  130 

CATATONIC  schizophrenic  symptoms,  Encepha- 
litis with  (Kim  and  Perlstein)  503 
CEYLON,  Leprosy  in  (Greenfield)  87 
CHALLENGE:  medicine.  Today’s  (Peplow)  (IL- 
LINOIS MEDICAL  ASSISTANTS  ASSOCIA- 
TION) 31 

CHARITY  HOSPITAL,  An  analysis  of  500  con- 
secutive cases  of  acute  appendicitis  in  a me- 
tropolitan (Sethi,  Matsuda,  Pemberton  and 
Strohl)  147 

CLINICS  FOR  CRIPPLED  CHILDREN  16;  119; 
197;  459;  489;  606 

COMMITTEES  of  ISMS  (Reference  Issue)  366 
COMMON  BILE  DUCT,  Argentaffine  carcinoma 
(carcinoid  tumor)  involving  the  ampulla  of 
Vater  (Stefanini,  Urbas  and  Crockett)  130 
“Community  aspects  of  epilepsy”  (MEDICAL 
PROGRESS)  (Boshes  and  Kienast)  140 
“Contemporary  Practices  in  Ophthalmology” 
(MEDICAL  PROGRESS)  (Bellows)  47 
Convention  Highlights.  See  CONVENTION  SUM- 
MARY. 


CONVENTION  SUMMARY 

1970  Officers  and  Board  of  Trustees  58 
Convention  Highlights  59 
Summary  of  House  of  Delegates  Actions  63 
Actions  on  Resolutions  68 
COUNCILS  of  ISMS  (Reference  Issue)  361 
Crockett,  Fred  L.,  jt.  author.  See  Stefanini,  Mario. 

D 


deHaen,  Paul  (NEW  PHARMACEUTICAL  SPE- 
CIALTIES) 26;  132;  226;  456;  534;  604 
DOCTORS  in  training.  The  plans  of  our  (SPE- 
CIAL ARTICLE)  (Breed)  536;  602 
Dunea,  George  “Hemodialysis  1970”  (MEDICAL 
PROGRESS)  594 

Dunham,  Mary,  “Improvement  through  educa- 
tion” (ILLINOIS  MEDICAL  ASSISTANTS 
ASSOCIATION)  452 

DYAD:  An  interpersonal  relationship  model.  The 
doctor-patient  (Garner)  133 


E 


EDITORIALS  55;  159;  257;  450;  538;  609 
“Educating  the  total  health  team”  (SPECIAL 
ARTICLE)  (Blythe)  170 
ELDERLY  PATIENT,  Medical  care  of  the  (Moss) 
527 

ELIMINATION,  Evaluation  of  hypnotic  effect  of 
methaqualone  employing  placebo  responder 
elimination  (Almassy)  73 
“Encephalitis  with  catatonic  schizophrenic  symp- 
toms” (Kim  and  Perlstein)  503 
EPILEPSY,  Commimity  aspects  of  (MEDICAL 
PROGRESS)  (Boshes  and  Kienast)  140 
“Evaluation  of  Hypnotic  Effect  of  Methaqualone 
Employing  Placebo  Responder  Elimination” 
(Almassy)  73 


“Failure  of  Thymectomy  in  a Six-Year-Old 
Child  with  Myasthenia  Gravis”  (Kim,  Sher- 
man and  Perlstein)  44 

FALLOUT  of  pollens  and  molds,  Meteorologic 
factors  in  the  (Heise  and  Heise)  224 
FIBROMATOSIS  of  mesentery.  Giant  fibroma 
(Lattuada,  Stefanini  and  Powell)  518 
“40-hour  week:  myth  for  Medical  Assistants” 
(ILLINOIS  MEDICAL  ASSISTANTS  ASSO- 
CIATION) (Jackson)  160 


G 


Garner,  H.  H.,  “The  doctor-patient  dyad:  An 
interpersonal  relationship  model”  133 
GENERAL  HEALTH  SERVICES  INFORMA- 
TION (Reference  Issue)  442 
“Giant  fibroma  (Fibromatosis)  of  mesentery” 
(Lattuada,  Stefanini  and  Powell)  518 
Greenfield,  Larry  D.,  “Leprosy  in  Ceylon”  87 
“Growth  is  a beautiful  word”  (ILLINOIS 
MEDICAL  ASSISTANTS  ASSOCIATION) 
(Lee)  251 

GRUNDY  COUNTY  and  Will  County— Pilot 
project  in  medical  review  successfully  com- 
pleted (SPECIAL  ARTICLE)  542 


H 


HEALTH  TEAM,  Educating  the  total  (SPECIAL 
ARTICLE)  (Blythe)  170 
Heise,  Eugenia  R.,  jt.  author.  See  Heise,  Herman 

A. 

Heise,  Herman  A.,  and  Heise,  Eugenia  R.,  “Me- 
teorologic factors  in  the  fallout  of  pollens  and 
molds”  224 

“Hemodialysis  1970”  (MEDICAL  PROGRESS) 
(Dunea)  594 

HEPATITIS  case.  Supreme  Court  decision  in 
(SPECIAL  ARTICLE)  (Pfeifer)  532 
HERNIA,  Lumbar — An  instance  reported  (Mu- 
sick  and  Schubert)  585 
HOSPITALS  (Reference  Issue) 
packaged  disaster  434 
private  mental  422 
with  special  type  of  service  421 
state  mental  422 

state  schools  for  mentally  retarded  422 
HYPNOTIC  EFFECT  of  methaqualone  employ- 
ing placebo  responder  elimination  (Almassy)  73 


I 


“Illinois’  Anatomical  Gift  Act”  (SPECIAL  AR- 
TICLE) (Pfeifer)  154 

ILLINOIS,  Departments  of:  (Reference  Issue) 
Children  and  Family  Services  404 
Mental  Health  412 
Public  Aid  403 
Public  Health  415 
Registration  & Education  406 
ILLINOIS,  Licensure  problems  in  (SPECIAL 
ARTICLE)  (Schnepp  and  McCarthy)  241 


for  December,  1970 


635 


ILLINOIS  MEDICAL  ASSISTANTS  ASSOCIA- 
TION 31;  160;  251;  393  (Reference  Issue);  452; 
540;  620 

ILLINOIS  MEDICAL  POLITICAL  ACTION 
COMMITTEE  (IMPAC)  (Reference  Issue)  390 
ILLINOIS  STATE  GOVERNMENT  (Reference 
Issue)  401 
departments  403 

hospitals,  laboratories  and  centers  436 
ILLINOIS  STATE  MEDICAL  SOCIETY 
Organization  (Reference  Issue)  323 
principles  of  medical  ethics  326 
constitution  and  bylaws  327 
policy  manual  342 

officers  of  county  medical  societies  351 
trustee  district  committees  358 
councils  and  committees  361 
Services  381 
divisions  381 

scientific  speakers  bureau  385 
physicians  placement  and  student  loan  fund 
385 

insurance  programs  388 
professional  liability  programs  388 
“Improvement  through  education”  (ILLINOIS 
MEDICAL  ASSISTANTS  ASSOCIATION) 
(Dunham)  452 

“In  Will  and  Gnmdy  Counties — Pilot  project  in 
medical  review  successfully  completed  (SPE- 
CIAL ARTICLE)  542 
INDEX  to:  (Reference  Issue) 
committees  380 
constitution  & bylaws  341 
ISMS  policy  manual  348 
“Intermittent  jaundice”  (SURGICAL  GRAND 
ROUNDS)  (Beal,  ed.)  125 


J 

Jackson,  Ruby  “40-hour-week:  myth  for  Medi- 
cal Assistants”  (ILLINOIS  MEDICAL  ASSIST- 
ANTS ASSOCIATION)  160 
JAUNDICE,  intermittent  (SURGICAL  GRAND 
ROUNDS)  (Beal  ed.)  125 


K 

Khedroo,  Lawrence  G.,  “The  private  nonaffiliated 
metropolitan  community  hospital:  Its  respon- 
sibility as  related  to  post-graduate  medical 
education”  234 

Kienast,  Hans  W.,  jt.  author.  See  Boshes,  Louis 

D. 

Kim,  Chang  Hwan,  and  Perlstein,  Meyer  A., 
“Encephalitis  with  catatonic  schizophrenic 
symptoms”  503 

Kim,  Chang  Hwan,  Sherman,  Bennett  R.,  and 
Perlstein,  Meyer  A.,  “Failure  of  Thymectomy 
in  a Six-Year-Old  Child  with  Myasthenia 
Gravis”  44 


L 

Lattimer,  John,  “The  wound  that  killed  Lincoln” 
514 

Lattuada,  Henry  P.,  Stefanini,  Mario,  and  Powell, 
Lewis  C.,  “Giant  fibroma  (Fibromatosis)  of 
mesentery”  518 


Lee,  Leslie,  “Growth  is  a beautiful  word”  (IL- 
LINOIS MEDICAL  ASSISTANTS  ASSOCIA- 
TION) 251 

LEGAL  COUNSEL,  Illinois’  Anatomical  gift  act 
(SPECIAL  ARTICLE)  (Pfeifer)  154 
“Leprosy  in  Ceylon”  (Greenfield)  87 
LICENSURE,  Medical:  Let’s  reciprocate  (SPEC- 
IAL ARTICLE)  (Burke)  240 
“Licensure  problems  in  Illinois”  (SPECIAL  AR- 
TICLE) (Schnepp  and  McCarthy)  241 
LINCOLN,  The  wound  that  killed  (Lattimer)  514 
Lotharius,  Joseph  L.  (SOCIO-ECONOMIC 
NEWS)  81;  161;  255;  451;  547  ; 627 
Love,  Leon  (THE  VIEW  BOX)  70;  129;  223;  508; 
588 

“Lumbar  hernia — An  instance  reported”  (Mu- 
sick  and  Schubert)  585 


M 


MALROTATION,  Mid-gut  volvulus  with  (SUR- 
GICAL GRAND  ROUNDS)  (Beal,  ed.)  589 

Matsuda,  Takayoshi,  jt.  author.  See  Sethi,  Su- 
shil  M. 

McCarthy,  William  G.,  jt.  author.  See  Schnepp, 
Kenneth  H. 

MEDIASTINUM,  Neurogenic  tumor  of  the 
(SURGICAL  GRAND  ROUNDS)  (Beal,  ed.) 
229 

MEDICAL  AND  PARAMEDICAL  EDUCATION 
(Reference  Issue)  394 

“Medical  care  of  the  elderly  patient”  (Moss)  527 

MEDICAL  CARE,  The  medical  student,  the  pub- 
lic, and  (SPECIAL  ARTICLE)  (Sheps)  598 

MEDICAL  LEGAL  INFORMATION  (Reference 
Issue)  436 

“Medical  licensure:  Let’s  reciprocate”  (SPECIAL 
ARTICLE)  (Burke)  240 


MEDICAL  PROGRESS 

“Contemporary  Practices  in  Ophthalmology” 
(Bellows)  47 

“Community  aspects  of  epilepsy”  (Boshes  and 
Kienast)  140 

“Hemodialysis  1970”  (Dimea)  594 
MEDICAL  REVIEW  successfully  completed.  In 
Will  and  Grundy  Counties — Pilot  project  in 
(SPECIAL  ARTICLE)  542 
MEDICINE,  Today’s  challenge  (ILLINOIS  MED- 
ICAL ASSISTANTS  ASSOCIATION)  (Pep- 
low)  31 

MEETING  MEMOS  31;  178;  192;  448;  552;  621 
MEMBERSHIP  FORUM  150;  298 
MESENTERY,  Giant  fibroma  (Fibromatosis)  of 
(Lattuada,  Stefanini  and  Powell)  518 
“Meteorologic  factors  in  the  fallout  of  pollens 
and  molds”  (Heise  and  Heise)  224 
METHAQUALONE  employing  placebo  responder 
elimination.  Evaluation  of  hypnotic  effect  (Al- 
massy)  73 

“Mid-gut  volvulus  with  malrotation”  (SURGI- 
CAL GRAND  ROUNDS)  (Beal,  ed.)  589 
Moss,  Bertram  B.,  “Medical  care  of  the  elderly 
patient”  527 

Musick,  R.  H.  and  Schubert,  Stephen  E.,  “Lum- 
bar hernia — An  instance  reported”  585 
MYASTHENIA  GRAVIS,  Failure  of  thymectomy 
in  a six-  year-old  child  with  (Kim,  Sherman, 
Perlstein)  44 


636 


Illinois  Medical  Journal 


N 

“Neurogenic  tumor  of  the  mediastinum”  (SUR- 
GICAL GRAND  ROUNDS)  (Beal,  ed.)  229 
NEW  PHARMACEUTICAL  SPECIALTIES  (de 
Haen)  26;  132;  226;  456;  534;  604 


O 

OBITUARIES  91:  124;  280;  464;  558;  621 
OBSTRUCTION,  Ureteral  (Beal,  ed.)  (SURGI- 
CAL GRAND  BOUNDS)  37 
OCULAR  trauma.  Pathology  of  (Scheffler)  522 
Officers  and  Board  of  Trustees.  See  CONVEN- 
TION  SUMMARY. 

OPHTHALMOLOGY,  Contemporary  Practices  in 
(MEDICAL  PROGRESS)  (Bellows)  47 


P 

“Pathology  of  ocular  trauma”  (Scheffler)  522 
“Paul  R.  Ehrlich:  A biologist’s  remarks  on  the 
“population  explosion”  (SPECIAL  ARTICLE) 
(Sloan)  246 

Pemberton,  L.  Beaty,  jt.  author.  See  Sethi,  Su- 
shi!  M. 

Peplow,  Thelma,  “To  be  or  not  to  be”  620 
Peplow,  Thelma,  “Today’s  Challenge:  Medicine” 

(ILLINOIS  MEDICAL  ASSISTANTS  ASSO- 
CIATION) 31 

Perlstein,  Meyer  A.,  jt.  author.  See  Kim,  Chang 
Hwan. 

Pfeifer,  Frank,  “Illinois’  Anatomical  Gift  Act” 
(SPECIAL  ARTICLE)  154 
Pfeifer,  Frank  M.,  “Statute  of  limitations  in  mal- 
practice lawsuits”  (SPECIAL  ARTICLE)  239 
Pfeifer,  Frank  M.,  “Supreme  Court  decision  in 
hepatitis  case”  (SPECIAL  ARTICLE)  532 
PHYSICIANS’  PLACEMENT  SERVICE  273;  541; 
607 

PLACEBO  responder  elimination.  Evaluation  of 
hypnotic  effect  of  methaqualone  employing 
(Almassy)  73 

“Popliteal  Aneurysm:  An  Unresolved  Problem” 
(Powers  and  Sejdinaj)  33 
POPULATION  EXPLOSION,  Paul  R.  Ehrlich; 
A biologist’s  remarks  on  the  (SPECIAL  AR- 
TICLE) (Sloan)  246 

POST-GRADUATE  MEDICAL  EDUCATION, 
The  private  non-affiliated  metropolitan  com- 
munity hospital:  Its  responsibility  as  related 
to  (Khedroo)  234 

Powell,  Lewis  C.,  jt.  author.  See  Lattuada,  Henry 

P. 

Powers,  Richard  C.,  and  Sejdinaj,  Isa,  “Popli- 
teal Aneurysm;  An  Unresolved  Problem”  33 
PRACTICES  in  ophthalmology.  Contemporary 
(MEDICAL  PROGRESS)  (Bellows)  47 
PUBLIC  AFFAIRS  LIBRARY  43;  163;  245; 


R 

Reference  Issue  Correction:  AMA  Delegation  611 
REFERENCE  ISSUE,  IMJ,  October  1970,  index 
to,  444 


RESPONDER  elimination.  Evaluation  of  hypnotic 
effect  of  methaqualone  employing  placebo  (Al- 
massy) 73 


S 

Savory,  Paul  B.,  “Arteriography:  principles  and 
techniques”  215 

Scheffler,  Milton  M.,  “Pathology  of  ocular  trau- 
ma” 522 

SCHIZOPHRENIC  SYMPTOMS,  Encephalitis 
with  catatonic  (Kim  and  Perlstein)  503 

Schnepp,  Kenneth  H.,  and  McCarthy,  William 
G.,  “Licensure  problems  in  Illinois”  (SPECIAL 
ARTICLE)  241 

Schubert,  Stephen  E.,  jt.  author.  See  Musick 
R.  H. 

Sejdinaj,  Isa,  jt.  author.  See  Powers,  Richard  C. 

Sethi,  Sushil  M.,  Matsuda,  Takayoshi,  Pember- 
ton, L.  Beaty,  and  Strohl,  E.  Lee  “An  analysis 
of  500  consecutive  cases  of  acute  appendicitis 
in  a metropolitan  charity  hospital,”  147 

Sheps,  Cecil  G.,  “The  medical  student,  the  pub- 
lic, and  medical  care”  (SPECIAL  ARTICLE) 
598 

Sherman,  Bennett  R.,  jt.  author.  See  Kim,  Chang 
Hwan. 

Slocm,  Michaelyn,  “Paul  R.  Ehrlich:  A biologist’s 
remarks  on  the  ‘population  explosion’  ” (SPE- 
CIAL ARTICLE)  246 

SOCIO-ECONOMIC  NEWS  (Lotharius)  81;  161: 
255;  451;  547;  627 

“Statute  of  limitations  in  malpractice  lawsuits” 
(SPECIAL  ARTICLE)  (Pfeifer)  239 

Stefanini,  Mario,  jt.  author.  See  Lattuada,  Henry 
P. 

Stefanini,  Mario,  Urbas,  John  E.,  and  Crockett, 
Fred  L.,  “Argentaffine  carcinoma  (carcinoid 
tumor)  involving  the  ampulla  of  Vater”  130 

Strohl,  E.  Lee,  jt.  author.  See  Sethi,  Sushil  M. 

“Supreme  Court  decision  in  hepatitis  case” 
(SPECIAL  ARTICLE)  (Pfeifer)  532 

Summary  of  House  of  Delegates  Actions.  See 
CONVENTION  SUMMARY. 


SURGICAL  GRAND  ROUNDS 

“Ureteral  Obstruction”  (Beal,  ed.)  37 
“Intermittent  jaundice”  (Beal,  ed.)  125 
“Neurogenic  tumor  of  the  mediastinum”  (Beal 
ed.)  229 

“Acoustic  neuroma”  (Beal,  ed.)  509 
“Mid-gut  volvulus  with  malrotation”  (Beal, 
ed.)  589 

SURVEY,  The  plans  of  our  doctors  in  training 
(SPECIAL  ARTICLE)  (Breed)  536;  602 


T 


THE  DOCTOR’S  LIBRARY.  See  BOOK  RE- 
VIEWS. 

“The  doctor-patient  dyad:  An  interpersonal  re- 
lationship model”  (Garner)  133 
“The  medical  student,  the  public,  and  medical 
care”  (SPECIAL  ARTICLE)  (Sheps)  598 
“The  plans  of  our  doctors  in  training”  (SPECIAL 
ARTICLE)  (Breed)  536;  602 
THE  PRESIDENrs  PAGE  (Breed)  11;  116;  194; 
297;  494;  573 


for  December,  1970 


637 


“The  private  non-affiliated  metropolitan  com- 
munity hospital:  Its  responsibility  as  related 
to  post-graduate  medical  education”  (Khedroo) 
234 

THE  VIEW  BOX  (Love)  70;  129;  223;  508;  588 
“The  wound  that  killed  Lincoln”  (Lattimer)  514 
THYMECTOMY  in  a six-year-old  child  with 
myasthenia  gravis,  Failure  of  (Kim,  Sherman, 
Perlstein)  44 

“To  be  or  not  to  be.  . . (ILLINOIS  MEDICAL 
ASSISTANTS  ASSOCIATION)  (Peplow)  620 
“Today’s  Challenge:  Medicine”  (ILLINOIS  MED- 
ICAL ASSISTANTS  ASSOCIATION)  (Pep- 
low) 31 

TRANSPLANTATION,  Illinois  anatomical  gift 
act  (SPECIAL  ARTICLE)  (Pfeifer)  154 
TUMOR  of  the  mediastinum,  Neurogenic  (SUR- 
GICAL GRAND  ROUNDS)  (Beal,  ed.)  229 
TUMOR  involving  the  ampulla  of  Vater,  Argen- 
taffine  carcinoma  (carcinoid  tumor),  (Stefani- 
ni,  Urbas  and  Crockett)  130 
TRAINING,  The  plans  of  our  doctors  in  (SPE- 
CIAL ARTICLE)  (Breed)  536;  602 
TRAUMA,  Pathology  of  ocular  (Scheffler)  522 


U 

Urbas,  John  E.,  jt.  author.  See  Stefanini,  Mario 

“Ureteral  Obstruction”  (Beal,  ed.)  (SURGICAL 
GRAND  ROUNDS)  37 

Unger,  Donald  L.,  “Why  does  asthma  occur  at 
night?”  123 


W 


“What  every  doctor  should  know  . . .”  (ILLI- 
NOIS MEDICAL  ASSISTANTS  ASSOCIA- 
TION) (Breinig)  540 

“Why  does  asthma  occur  at  night?”  (Unger)  123 
WILL  COUNTY  and  Gnuidy  County — Pilot 
project  in  medical  review  successfully  com- 
pleted (SPECIAL  ARTICLE)  542 

WOMAN’S  AUXILIARY  (Reference  Issue)  390 
WOUND  that  killed  Lincoln,  The  (Lattimer)  514 


Community  health  effort— means  to  an  end 

This  doesn't  mean  that  a large  university,  like  Yale,  should  immediately 
accept  the  full  responsibility  for  all  the  health  care  of  the  city  it  inhabits, 
but  it  does  mean  that  representatives  of  the  university  must  sit  down  with 
members  of  the  community— with  sleeves  rolled  up,  so  to  speak— and  join 
in  the  CHP  effort:  give  guidance,  hear  out  the  problems  as  they  exist  and 
are  presented,  and  put  some  of  their  best  scholars  to  work  on  devising 
and,  at  times,  actually  carrying  out  more  effective  means  of  meeting 
community  needs. 

None  of  this  is  intended  to  be  an  assault  on  Yale,  I hasten  to  add;  these 
recommendations  apply  nationally.  As  a matter  of  fact,  Yale  University 
is  more  deeply  involved  through  its  department  of  a prepaid  group-prac- 
tice plan  for  the  New  Haven  area.  (Similar  plans  are  being  developed  by 
Harvard  and  Johns  Hopkins  in  their  areas.) 

It  seems  to  me  that,  sooner  or  later,  we  shall  all  have  to  recognize  that 
the  crucial  point  about  Comprehensive  Health  Planning,  on  which  will  de- 
pend the  verdict  rendered  by  our  great-grandchildren,  is  whether  or  not 
it  actually  solved  unmet  health  needs,  as  it  sought  to  meet  the  immediate 
wishes  of  citizen  groups  in  the  search  for  political  relevance.  Health  is  all 
too  often  used  as  a means  to  some  other  end,  but  the  test  of  success  to 
physicians  must  eventually  be  "health  as  an  end  unto  itself."  (George 
James.:  The  Comprehensive  Health  Planning  Program.  Medical  Opinion  & 
Review  (Sept.)  1970,  pages  44-45,  49.) 


638 


Illinois  Medical  Journal 


THE  TOTAL  BILL  FOR  PERSONAL  HEALTH  CARE  IN  THE  UNITED  STATES  IN  1969  WAS 

$52.6  billion,  according  to  statistics  just  released  from  HEW. 
Of  this  total,  the  aged  (65  years  and  older)  received  six 
times  as  much  in  per  capita  expenditure  as  did  the  na- 
tion’s yonth  (under  19  years)  and  two  and  one  half  times 
as  much  as  those  persons  in  the  intermediate  age  group. 
Differences  in  the  amounts  spent  for  medical  care  of  the 
three  age  groups  varied  considerably  with  type  of  expendi- 
ture. 

Per  capita  hospital  care  expenditures  for  the  aged  were 
more  than  12  times  those  of  the  young  and  more  than  two 
and  one  half  times  those  for  the  intermediate  age  group. 
For  physicians’  services,  the  average  expenditure  for  the 
aged  person  was  three  times  that  for  a youth  and  less  than 
twice  that  for  a person  in  the  intermediate  age  group. 

•I"*I**I"“I**I**I**l**I**I**I**I**I*"I"*I**I**I**I**I* 

IRS  NOW  PERMITS  LONGER  PER-MILE  DEDUCTIONS  FOR  BUSINESS  USE  OF  AUTOS.  The 


tax  allowance  goes  up  from  the  recently  prevailing  10^'  a 
mile  to  12^.  The  new  deduction  for  medical  use  has  been 
laised  Irom  5(^  to  6^:  per  mile.  Parking  fees  and  tolls  can 
akso  be  added.  The  increased  allowances  become  effective 
this  year. 

VIEW  BOX  (Continued  (rom  page  388) 


DIAGNOSIS:  3.  Tuberculosis  (Fig.  3) 
d'he  PA  chest  revealed  an  alveolar  type 
infiltration  with  suggestion  of  cavities  in 
both  upper  lobes  and  bronchogenic  spread 
down  through  the  right  lower  lobe  and  into 
the  left  mid-lung  held.  The  point  of  interest 
in  this  case  is  rather  subtle.  You  will  note 
that  the  paravertebral  shadow  on  the  right 
at  the  level  of  D-10  and  D-11  is  displaced 
somewhat  laterally.  It  is  distinctly  out- 
lined on  the  left  as  well  in  a displaced 
fashion.  Figure  2 demonstrates  dehnite  dis- 
placement of  the  paravertebral  shadow  on 
the  left  as  well  as  the  region  of  D-11  and 
D-12,  which  indicates  that  there  is  evidence 
of  a paravertebral  mass.  Figure  3 demon- 
strates a marked  narrowing  in  the  inter- 
vertebral disc  space  between  D-11  and  D-12 
with  some  loss  of  bone  substance  on  the 
anterior-superior  aspect  of  D-12,  which  is 
indicative  of  a Pott’s  abscess  associated  with 
tidrercular  involvement  of  the  dorsal  spine. 

It  is  important  to  recognize  certain  lines 
which  are  visible  within  the  mediastinal 
contour  on  a well-exposed  PA  chest,  since 
deviations  and  their  pattern  may  supply 
important  clues  to  the  presence  of  disease. 
I'he  reflection  of  the  pleura  from  the  pos- 
terior thoracic  wall  onto  the  right  side  of 
the  mediastinum  is  smooth  and  uninter- 
rupted hy  protruding  structures  except  for 


the  right  atrium,  the  superior  vena  cava 
above,  and  the  inferior  vena  cava  below.  It 
is  invisible,  therefore,  on  PA  fdms  of  the 
chest.  By  contrast,  on  the  left  side  the  de- 
scending thoracic  aorta  protrudes  slightly 
laterally  in  the  posterior  mediastinal  com- 
partment causing  a lateral  displacement  of 
the  mediastinal  pleura  jmsterior  to  it.  This 
creates  the  paraspinal  line.  It  consists  of  a 
longitudinal  density  projected  about  mid- 
way between  the  outer  border  of  the  de- 
scending thoracic  aorta  and  the  vertebral 
column  extending  from  the  aortic  arch 
above  to  the  diaphragm  below.  Some  of 
the  reasons  for  deviation  on  this  shadow 
may  be:  1)  Infections  of  bone,  such  as  tu- 
bercidosis  and  vertebral  osteomyelitis  with 
soft  tissue  extension  displacing  the  verte- 
bral shadow;  2)  Metastases  in  the  dorsal 
spine  with  extension  out  into  the  soft  tis- 
sues; 3)  Dissection  of  the  thoracic  aorta 
with  hematoma  extending  laterally;  4)  Frac- 
ture of  the  dorsal  spine  with  paravertebral 
hematoma;  5)  Enlargement  of  the  lymph 
node  chains  extending  up  from  the  retro- 
peritoneal space;  and  6)  Enlargement  of  the 
hemizygous  system  for  purjroses  of  collat- 
eral pathways.  The  importance  of  observ- 
ing the  paravertebral  line  as  a first  clue  to 
serious  underlying  patholog7  is  demon- 
stiated. 


for  December,  1970 


639 


CLASSIFIED  ADVERTISING 


Positions  & Practice  Opportunities 


LOCUM  TENENS— Try  General  Practice  tor  8 months  or  1 
year.  Pleasant  Chicago  suburb,  near  excellent  450-bed  hos- 
pital. May  continue  in  area  if  desired.  Call  (312)  TE  4-6084. 


WANTED:  GENERALIST,  OBSTETRICIAN-GYNECOLOGIST  and 
INTERNIST  for  eight  man  group.  Thirty  miles  southwest 
Chicago.  Excellent  hospital,  housing  and  schools.  Guaran- 
tee $30,000  to  start.  Write  Box  Number  782,  c/o  Illinois 
Medical  Journal,  360  N.  Michigan  Ave.,  Chicago,  Illinois 
60601. 


OBSTETRICIAN-GYNECOLOGIST— Excellent  opportunity  for 
Board  Certified  or  Board  Eligible  Physician  for  solo  practice 
in  Western  Illinois  Community  of  51,000,  located  in  metro- 
politon  complex  of  350,000.  New  350-bed  hospital  now 
near  completion.  Immediate  hospital  appointment.  Com- 
munity offers  fine  recreational  and  educational  facilities. 
For  Information  Call:  Chairman,  Physician  Recruitment,  c/o 
St.  Anthony's  Hospital,  Rock  Island,  Illinois  61201.  Tele- 
phone (309)  788-7631. 


INTERNIST  NEEDED:  To  join  9 man,  all  specialty  group  of 
2 Internists,  2 Surgeons,  2 OB-GYN,  and  3 Pediatricians. 
City  of  40,000  located  1 hour  drive  from  Milwaukee  on 
Lake  Winnebago  which  serves  a medical  area  of  75,000. 
Single  hospital  of  350  beds.  Area  affords  excellent  sum- 
mer and  winter  recreational  facilities.  Superior  schools, 
public  and  parochial  and  2 colleges.  Excellent  initial  salary 
leading  to  partnership  in  one  year.  For  further  informa- 
tion, phone  or  write:  W.  G.  Kendell,  M.D.,  The  Sharpe 
Clinic,  S.C.,  92  E.  Division  Street,  Fond  du  Lac,  Wisconsin 
54935.  Telephone  (414)  921-0560. 


SURGEON  or  GENERAL  PRACTITIONER  WANTED  with 
thorough  surgical  experience.  Illinois  community  of  5,000 
population  on  Mississippi  River  50-bed  open  staff  hospital. 
Exceptional  recreational  facilities.  Excellent  schools.  Only 
physicians  in  town  are  practicing  as  a partnership.  Incom- 
ing physician  may  practice  on  his  own  or  join  partnership. 
Group  will  give  $28,000  first  year  guarantee,  $50,000  to 
$60,000  potential.  Send  reply  to:  William  J.  Dayton,  202 
Meadowview  Knoll,  Savanna,  Illinois  61074. 


INTERNISTS  (2)  WANTED  to  join  3-man  internal  medicine 
professional  corporation.  North  side,  Chicago.  Minimum 
salary  $25,000.00— 1 st  year.  Phone:  (312)  AMbassador  2- 
1113. 


DIRECTOR  WANTED  for  University  Health  Service  to  direct 
and  develop  a multi-disciplined  health  service  in  a grow- 
ing university;  17,000  students  presently.  Out-patient  fa- 
cility only.  Salary  based  upon  qualifications.  Write:  Oscar 
Miller,  Dean  of  Student  Affairs,  University  of  Illinois  Circle 
Campus,  Box  4348,  Chicago,  Illinois  60680. 


BOARD  CERTIFIED  PSYCHIATRIST.  Average  daily  census- 
1204;  predominately  psychiatric  VA  Hospital,  located  in 
East  Central  Indiana.  Special  programs  in  psychiatric  and 
geriatric  rehabilitation;  alcoholic  treatment  unit.  Active  medi- 
cal service.  Family  rental  units  at  reasonable  rates 
usually  available  on  hospital  grounds.  30  days  leave 
annually;  retirement;  health,  life  insurance  plans  without 
physical  examination;  and  other  benefits.  Will  pay  moving 
expenses.  Salary  $19,643-$29,752  depending  on  qualifica- 
tions. License  any  State  required.  Equal  opportunity  em- 
ployer. Contact  Chief  of  Staff,  VA  Hospital,  Marion,  In- 
diana 46952,  or  call:  Area  (317)  674-3321. 


IMMEDIATE  9PENING;  INTERNIST  or  GENERAL  PRAC- 
TITIONER to  join  six  man  multi-specialty  group  in  north- 
eastern Wisconsin.  Excellent  professional  opportunity  to 
practice  in  a friendly  community,  only  two  actively  prac- 
ticing physicians  (General  Practitioners)  in  the  community 
outside  of  our  Clinic.  Salary  commensurate  with  training 
and  experience  first  year  and  then  full  partnership.  Ideal, 
safe  small  city  living  for  the  family  on  scenic  Lake  Michi- 
gan with  excellent  fishing,  boating  and  hunting.  All  this 
and  stilJ  only  IV2  hours  drive  to  Milwaukee  or  45  minutes 
to  Green  Bay  or  lovely  Door  County.  For  complete  details 
contact  Robert  E.  Myers,  M.D.,  Garfield  at  23rd.  Two 
Rivers,  Wisconsin  54241. 


GENERAL  PRACTITIONER  WANTED  to  join  four  General 
Practitioners'  Group  in  young  suburban  community  of  100,- 
000.  Tired  of  long  hot  summers— cold  winters  alone  on 
call?  Move  to  San  Francisco  Bay  Area— mild  climate.  Must 
have  California  license  and  no  military  obligations.  Forty- 
five  minutes  from  downtown  San  Francisco.  Salary  leading 
to  partnership.  Contact  Phillip  M.  Loeb,  M.D.,  Center  Medi- 
cal Group,  2190  Peralta  Blvd.,  Fremont,  California  94536, 
Telephone  793-2645. 


UNUSUAL  OPPORTUNITY  FOR  PHYSICIANS  who  wish  to 
supplement  a young  practice  or  teaching  position  or  who 
prefer  not  to  maintain  on  office  to  join  a rapidly  growing 
fee-for-service  group  in  the  Emergency  Departments  of 
Chicagoland  hospitals.  Flexible  work  schedules,  16-48  hours 
weekly.  Prefer  surgeons,  general  practitioners  with  experi- 
ence in  traumatic  medicine,  or  those  specifically  interested 
in  high  standard  Emergency  Care.  Group  is  expanding,  de- 
veloping teaching  programs.  Excellent  facilities,  automated 
billing  and  collecting  service,  opportunity  for  research  in 
emergency  procedures  and  programming.  Ideal  for  physi- 
cian desiring  high  remunerative  compensation  for  circum- 
scribed work.  Address  reply  to:  Medical  Emergency  Service 
Associates  (MESA),  S.C.,  111  North  Addison,  Elmhurst,  Illi- 
nois 60126.  832-4504. 


URGENTLY  NEEDED:  General  Practitioner,  Orthopedic  Sur- 
geon, Otolaryngologist,  to  supplement  staff  of  nine  man 
multispecialty  group.  Beautiful  new  building  with  space 
available,  located  across  street  from  new  ftve-hundred-bed 
hospital.  Suburban  location,  but  only  30  minutes  from 
down-town  Chicago.  Generous  starting  salary,  and  part- 
nership after  two  years.  Contact  Mr.  G.  A.  Caress,  Man- 
ager, Pronger-Smith  Clinic,  2320  W.  High  Street,  Blue  Is- 
land, Illinois  60406,  Phone  FUIton  8-5500. 


NEW  EXPANDING  OPPORTUNITIES  for  family  physicians 
and  physicians  specializing  in  pediatrics,  internal  medicine, 
anesthesiology;  in  medically-awakening  community.  Con- 
temporary, automated,  105-bed,  new  hospital  to  be 
completed  In  the  fall  of  1970.  Present  hospital  to  be 
converted  into  long-term  unit.  Patient  service  area  50,000 
people.  Medical  staff  leading  and  supporting  recruitment 
efforts.  Excellent  community  location,  forty  miles  equi- 
distant to  Milwaukee  or  Madison.  Complete  educational, 
cultural  and  recreational  facilities.  A new  medical-dental 
building  and  a 130-bed  skilled  care  nursing  home  being 
constructed  adjacent  to  the  new  hospital  ready  for  occu- 
pancy January,  1971.  Immediate  satisfaction  in  practice, 
income  and  family  living.  Special  assistance  if  needed. 
Write  or  call  Paul  R.  Glunz,  M.D.,  Watertown  Memorial 
Hospital,  1301  E.  Main  Street,  Watertown,  Wisconsin  53094. 
Telephone  414-261-4210  for  more  Information. 


FOR  SALE,  LEASE  OR  RENT 


FOR  SALE:  General  Practice,  Chicago  Northwest  Side,  estab- 
lished 28  years,  full  equipped,  net  over  $40,000.  Retiring. 
Nominal  cash,  terms  to  suit.  Call  (312)  252-0494  or  write 
Box  Number  781,  c/o  Illinois  Medical  Journal,  360  N. 
Michigan  Ave.,  Chicago,  Illinois  60601. 


GENERAL  PRACTICE  for  sale.  Desirable  Chicago  suburb. 
Excellent  450-bed  hospital,  3 biks.  from  office. 

Over  $60,000  net.  Call  (312)  834-6084. 


FOR  RENT:  Lake  Forest,  Illinois.  Office  space  available  in 
new  air-conditioned  Medical  Building  in  center  of  town. 
Elevator  and  excellent  parking  facilities.  Call  Dr.  E.  Kadi- 
son— Telephone  295-1220. 


FOR  RENT:  Physician's  office  for  one  or  two  physicians  in 
modern  downtown  building,  ground  level  location  with 
parking  facilities.  West  Chicago,  Illinois.  Full  equipment 
available,  for  rent  or  option  to  buy.  Three  hospitals  in 
eight  mile  radius.  Area  desperately  needs  physicians  in 
all  categories  of  practice.  Please  correspond;  KJK  CORPORA- 
TION, 27  Cass  Street,  Lemont,  Illinois. 


Illinois  Medical  Journal 


X72-2044 


Illinois  medical  journal. 

V.I38,  1970. 

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